vA Aan Melbourne, February 2004 L 17y old has problem seeing signs on the road, while driving. Father and beother have glasses. Worried about his cyesight. examine eye sight (sncUlen chart) advise on management 2 23 y old present to ED with pain in R back radiating to R thigh. Pathology results N except for blood in urine. Currently in no pain. further investigation, explain to him your diagnosis advise on farther management 3. 26 y old female preseat to ED with abdominal pain that came on suddenly after large meal of fish and chips. -perform physical examination -additional investigations differential diagnosis 4. . 46y old woman comes to your GP surgery with complaint that her L leg gives away. take focused history -further investigation ~discuss differential diagnosis with examiner 5. 23 y old primipara; child developed jaundice in first 24 hours, billirubin 244/6. Child otherwise well, feeding well, alert. Mother wants to go home ASAP. -DD newbom jaundice SO Re explain to mother and decide on management . 6. 60 y old married lady comes to GP complaining of yellow-brown discharge. “management 7. 63,y old man came to GP complaining of pain in R calf ~take focused hi -discass DD with exanwiner advise on management iy old mother of 4 months old baky presets to GP with complaints of tachycardia. ‘You do ECG and resuit is sinus tachycardia. “take focused history ._ -discuss investigations and management9. ‘65,y old man wants to travel overseas and comes to you for check up before departure examine his neart -advise on diagnosis “management 10: : ‘Primigravida presents to GP for check up at 30 weeks. BP 170/110, dipstick urine Protein H+ u. ~4 month old baby, previously well, brought to ED. T 37.4, not feeding well for last couple of days, dry nappies. Chest: crackles and whoezes. Father’s brother died from pneumonia. Farther worried this might be pneumonia and ‘that baby will die. -ativise on diagnosis “management 2 ~64y old coming to GP (she previously had a fall and X-ray was done showing collapsed vertebra). Bone densitometry shows (result-low) ~advise on diagnosis : “management . 1B. ~on regular check up at-28 woeks fasting glucose level was 6.7 mmol and 2 hour post GGT was 89 ee : advise Gn diagnosis, explain cmmgeneii—— 14, ~22y old student living with parents (teachers) presents with old laceration of L wrist, says she doesn’t know how it happened “mental state examination 46 old woman presents with complaint of lumpiness and discomfort. She is in 3 week of her cycle. You did examination and find diffuse humping breast with no Local lymph nodes colarged. She is worried that she might get Ca as her mother. -advise on diagnosis further management 16. ~Mother of 4-yeat-old child comes to GP for advice. Worried and upset that her son is - Still bedwetting. He has been dry since 2 years during he day ~urine dipstick NAD, advise on managementL Clinical Exam, Sydney 27° Exam was held at Sydney Children Hospital 4 12h. 10 mia. The Professor Paget, one of the Allcandidates have beea divided randomly signed an attendance sheet, thien I have.got 4 aumber/station on it. We waited until the morning group finished so make sure that you have enough food or di Now, about exam. I tried to write as much as difficult to recollect everything what have bet So please read the others people feedback an: guide for exam. Inet Station 1. oxo + 218,215 A laminated A4 pay primigravida already had an US at 18" week placentas, two separate foetuses. Her HB-was to the patient. Do net take history. I wes a bit nervous and I started paniéking ab} I entered the room, and.meet a young student way at least halfof the examiners had a badgel were very correct and didn’t try: to trick you. So, Lintroduce myself to the examiner and pat are going?” She replied shejs fine: I want to there are any history of tiypertension, whist is| examiner interrupted me, saying: You don’t a| about her pregnancy. Then I said: What do you know. about your co, © two babies, talked ‘about anaemia, increased during the. + fron-& Poli talked to her about the complications during ti © polyhydramnios, immediately overstietetied talked about PPH, pre-eclanipsta, increased in mentioned foetal complications.like promatiiri more common, She asked me: Can will need more antenatal visit etc. Isaid that pi tecm and then bell rang, Isaid Good buy and did I pass this station or not. Anyw: not give me wny feedback or he the next door( station syed Che CF Mareh 2604 their exami, ‘per was hang on the wail with a shorf sdenario. ‘A 25-y.0. | AOG. US s and Proféssqr exathirier By the pregnancy. Although your Hb is.13)g the, baby di ay, it was my first station and-examiner did i ere Belf raiig aiid Imoved to @®. mor as SYED Essa. it Randwick: Reporting time was IC co-ordijator, has greeted us. two groups|(a blue or orange). blue cerd:with a starting am started at 2 PM, iaks or.at least a good breakfast. temembere, but it’s really on. said or written itt the scenarios. compare, This is a like rough . poet fewpiscehes recess |B) Pobyiny fy peerlenpsir, . Wrens eed site lifent pry blen . BP Wstiowed atwo piecewler pie 3.0 g/4L. Please explain condition pvelesr~ Leabor PP — Hh afin meretewine, of “aeinerl dana chegs bovos ( ut Twine pregnancy. Bell rang, Rfewi & Professor Dr but all oftiiem_ > peateades | that shehad Ons hy T stat. LUO RK aherDoyouhave . ric cbinplications. Then 1 shrek ja erst e pregnant like : terus came yp:on my-tnind) 30 1 iderice aswell: ThenI yyalso lighthfor-dates babies are, 2? Well it could happen so you sgnanoy shuld not go beyond the Joff the rooth, and f wasn’t sure iinutes pagsed alteady, fn henprncaah 2 poty te 7 ae BEL Ege he Rigi%, 7 gem Station 2. , GP. 254, 4 IPs. lob Me 143 ' . & Young man returned from Thailand, hed sex with = prostitute and he wants a V test, Tt was counsellingistation. Almpst everyons knows about th cenario, a comsion sase, Liook 3 short history, ask why he wants HIV lest frees history, he injected himself with the drugs nat is ovr peciod “, Western blow red dibease etc. In bak (dug user) .i explained to him whet implicatio, (¢.g. insurance, employzient, relationthins e: inet, old dector, asked " re specifit: Elisa or Westera blot ? I said Westera blot lisa is a screening test. The! a asked me what other test Tshould do. I really didn’t know what to say, so he intdrrupted silence saying: What ire RPR rest? Tsaid T know what is a PCR but I deally don’t know what is 4 RER The he "Said: What is VDRL lest? said. ~ syphilis. Then he asked met Toke syphilis on increase or decrease. On inctease, I reply — frankly, it was my beat guess, but was Rappy and I was happy tog. I asked patient: Do-you have any question for me? No, doc thanks ydu, Tknew that I paseed this station, tation 3. ity BX OPH), oxsp- / A 19-year-old woman had sudden onset df right-sided chest pain. You sent her to ak pon the X-ray, now she retiraed with X-ray, bo please talk tote, ., Peas por When I entered the room, examiner (Professor Dr, of fadian descent) asked me . Gypnoes straightforward: What will be your Dx? Well I said, it could be. Paeumothorax, 4 4 eilfane PE, even MI. He said : Wotlld you consider MI in 19 y.0.? " Nex Tikely, I reply, eons but Tl Kept that on my mind as remote possibility: OK he sane Thea hechowed, 1) gto). [-+ | prevnalrerce the Ieft.: Anyhow, He showed mie some ait in interpleiiral spate and asked what sort of pneumothtex is thie wens exclude trauma it is spontaneous pune: imothorax, I replied. ‘OK, he agrees with me. The he'asked me wi treatment. I don't know why, but Itold him that treatment yeill be taserti rc eee TCS iSesitiery line. He asked: Met day she hts pneumothorax 25 % “Ae you going « wl, cbuckeo™ to insert chest alin this eas? really ida’t understand what he Want to ask cor) me anyway It was like of pufting me.back on the track and I quickly realised aft gifs tos that, so said: Look, the chést drain it willbe treatment for significant ad_-cxilleny, paeumothorex with collapse Tung, but ih her case Fwill lat ber Boome, put eee niedvout before that Iwould like to investigate wiht is cause of agers oepiors se pneumothorax ond than Tampa imbntioned evelything from etary ima, to Marfan’s. Soin Rap’). ber case I will ask her to conte within.a 7|days to make another CREE and or Bienes course I mentioned if conditjon getting wore she should Sook medical attention “C B immediately. Then exarained asked me: /hat would be indication for admission Promwacthevee Rrobe bbs pith Rebaserignib te ppittior ro, fhobusieny liboslgni ffamtailsp jnoea and- Heng eins Swe ABG will be decisive factor. Anyway, 1 bey id not have time to do that. eget obese iat spenkeneculy [ach ta” eateyiv ex q BP Ay gece esenat ef bij” oleic he fhe 1, Sis. ely, rem Pah Fea el st pasitent $ ; ie cae 2 Tebeegerie re ete n we oe teh dus. feccnenl oleh so, 4 ; \ rnin poten popation! is a young man, He had right anterior shguider dislocation a 6 months ago. He went through inggnsive rehabilitation, abw he is OK, Please - iPexamine his shoulder and axiflary‘nerve and ‘ive advice.t¢garding playing ‘Tiakpaisthngaiaung man, was sitting in the sre ‘greeted me. [examined the shoulder (check this out in Talley- O'Connor), tested: power. Lexplained his condition to him, told him to take sxtra se tions wheajte playing basketball or swimming, Explained him that he should prevent < ik" actually, he should prevent abduction.and external;rotation. I have d¢ what is abduction & ext: rotation. » In addition, 4 told hur dislocations might requite surgical'recoristrustion (Baa! asked me? Are you going to refer me,to ortho} aedi¢’su necessary you almost totally recovered from she injury, follow my instruction, what T said previously He Ww Examiner (again Professor Dr) asked me.only.one.que axillary nerve?: C5 & C6, F finished thet statfon befo: room eatiier sin thatcase ifyou have finished station you have to wait again in front the'sdme: ‘oor of you ¢: With examiner .I thought itis better to wait throw a question-on you. Station 5. Qyoe, 66 A.25-year-old woman had a spontaneous migeerriage 6 months agoin I a ese? irimerter. She eame in ER, complaining of pgin & vaginal bleeding. Take BIStO2Y "py + BSS ATT and manage the patient, Iwas! bitnsrvdus becuse] hig Thaveto, teat one Oo aecologica/Obstetric station if { want to, passcxamn: « and you wasting a precious tiie t for Rh factor. Lsaid Fwant fox know? Taske examination: PoC hanging o a that, he said talk to patient. Well, explained (que derteBranedetetipielalspoekondery t pr cervix), explain thanbaenedtovremiove Blood group save, ctoss match, resuscital hospital. Notify gynaecologist. Obviously, examiner was happy with my anywes, however the patient (probably medical student) asks me: Why it is happening to me? (Reouerent miscarriage L told her-causes of recurrent miscarriage fg 1 trimester and then explained eit 1g i lupus antiboagulant — phospholipids AB or cardiolipin antibodies, Also 1 will check her BSL. (DM #) CB VO oe EEN mewn jy bah P 2 BBSStation 6. 3 date age women has been in the court shy. ago. Her husband had bling debt, so at that time, she collapsed atthe court and she could not walk. Freeecda the court again today; gambling debt again was issue in the court so she cannot walk. ‘2 her lower Hienb and manage the patient. tnocked on the door, entered the room, Infreduce myself to examiner (again Professor Dz). Patient was a young lady (prqbably medical student) sitting on the Seranted to talk tovher, but examiner said to|me: You do not need to take history. it is amazing how many times Obviously, candidates have problem with atime. Lasked pdtlent ission to examine her lower limbs. 1 seid: Ifyou feel unconsfortable during the examination please let me know. So T examined lower limb exactly fom Telley & O’Counor. Nothing abgoraial was dound. No wasting, tone, power, and reflexes everything was fine. Then I took car key from my pocket fo check Babinsld; hefaid it is not necessary. After the examination, he offered me h4nd-washing gel and asked me what is my impression. [said that NAD ow lower limb ¢xamination therefore most likely it is psychologiseloanaaineesutieria or Hswader. What could be DDX he asked? I said 1tcouk siralingrting But 29 ‘3|funderstand her husband was plaintiffnot her. Anyhow, I éid correctly perform lower limb examination and I’, pyas sure that Iwas passed this-station. Alse I felt confident again. (I mentioried. previously that I was not happy with my performance in Station 1 & 3). ain Heap ger wile exclude | somehectes 364 2? =D. P . aoa, Station 7. G0 ake Ayoung woman had-a RTA a few hours s briefly lost her consciousness. Now she is OK. Please examint her cranial nerves 3 — Vi. a Tt was like a“* bread and batter” ; amy family members craniai nerves: at least 10 times, so F think aft n knows how to examine optical nerve. Anyway, check this outlin Talley & O'Connor and make sure that you can do that within 5-6 minutes, Praotice this to make it look very smooth. Do running commentaries if you'want. : a The patient was a. young giikmedical sh ijlent). asked her: Do you know-what happened? She said: No, Lari very blank, Fannot remember anything. ated bead, for fijuries, check Betstaien, base-oftheskull), clissk ears & nose for CS as itis written in the B ; hat pin, cotton tip etc.'So don’ ing, you. Examiner was Professor} approx: 60 ¥.6.- the hest pérssni 1 meet this © aftenoon. I knew that this stetion should hot be problem for rhe, Tiractised this ~~ so many times, but you know there are ahyays factors'— anxiety & nervousness. 2 23 4 be confirmed, nodding his head. It was encouraging, like youBacker mnvarsres Kp , ie pats fice’ eudhosrtee . & _— Station, Ox OF 7 FRE B- ‘ I op ' | ce Genbewkeing.. Meyes A 28y.0, woman has & pelvic pata for the iagt 12 months, we daheuferine po Take history, examine and menage the patient helen potyp Ltook detailed gynaecological history, ehcp related to periods, 2 ae dyspareunia, she is not on OCP, and otherwise she is ite Lwarited toxexamine 9 2 do fs the patient so I asked ‘firstto palpate abdomen he said? NO tendéracss, no - = rebound tenderness. Then om vaginel examination Examiner: said: The patient - Ciyvewiow ~ has retroverted uterus, a few nodules palpable on uteroseprel ligament Gotcha “Pad _ Endometiiosts, I seid thiat she will ed US to exchide! lsthér most definite diagnosis is made on laparoscopy, Then Ex act gald to, me: Talk * to patient and explafsi condition to her. Tt wa} like @ patient educstion explained to her in lay term what is Endometriosis, seid that there an (COC, Primolut'N, Danazol, ) and surgical tisatment, She asked me what’ Gynaecologist going to do if he fined Endometriosis én tapaioscopy. Lexplained that he would do diathermy; as well, there are other areal options from laser ablation to hysterectomy (obviously she isnot candidate for this, young & no family). : ve Wt wpe 9 Station 9. Geox 3a}, 6-P 771 50 y.o. women feels tired for the last few months. Tentered a rooin, introduced inys4lf, Gxaininbr was decent, He said: Take history fromthe a we Ls Werptease ask me 0 a . : ‘Woman looked tired,better say: history ‘she is comspipated,: findings consistent with bapoyrentism. 4 like to examine her, Hé gsked ine-whet Lexpps examination. ksai jgpeaieny' there is bradycardia hereplied: THe T made mistake saying patellar; ‘actuals what investigation, I will do? besieb miner was XE ead of schet find normochromic mecrocytic anaemia; Bx smiling alt the time. Efinished this station. Station 10. Ba. 43.) OP ey ASS y.0. woman-has a left lower abilomin Please take history and manage the patient I took detailed history, from the lady (role player) askedjber about pain. She said, actually, it is not a pain; itis a bit mor like a'discomfort. Besically non - specific discomfort. I was very through in history teking so this’ was ‘the clue to ts . . PID. ieey +thisstation-She.said sheis bit tired.” Sifd to immediately asked her: Why you taking replied. Then [ asked her about her bowel Id me that she taking Senokot. at? Because Tam constipated, she habit, she said constipated But when she takes Senokot, she has diarrhoea. Then Tasked specifically about stool (mucus, blood etc). She said; no blood in the toilet paper. Then I asked for the FH of lied, my father died from colon cancer. 1 lost~ 6 kilos ie last 6 MORLS. Then 1. end symptoms you've gat Ciel: ed some biood on (bowel cancer ). Yes, she > ced her about weight loss? Yes, ‘ou know, regarding your FH in bowel habit, blood )you may ht loss, thang have colon cancer, I will refér you to the sirgeoi aad he Wil investigations, ike sigmoid: wpylcolonascopy. i said before I refer you to specialist Iwill do FBC (looking for adidemia), Then I asked her about her. family broth ‘Thea I mentioned that he sistét. Yes, thave brothed she said. asked her: Is there is anythi needs to be screened as weil (FOBT). At the end, I else "2 would like to know? No, thank you docto: ed to me that she is satistied how consultation was conducteld. Then she asked Examiner (woman who wes sitting in the comer): Do you Have any question? No, she said, he coverad almost everything, I finished this station so I left r001 scheduled ‘time, alba cov] ipoet Station Li. Gi@P 238 fat mal’. |Fep An 18 months old child has bacterial growth in urine (E. coli > 100.000 cf), x & nok, Baad He/she has been given antibiotics and chifd is now OK. Please talk to his/her . mother. No history taking is necessary. fad Tabk te introduce myself to the mother will refer her child to paediékrfeian to im TAP xT rok, 2. Practise tina Boot, (role player doctor or medical student). Isaid P igate. (US and MCU). She said: Why d to her “every-child, with is that? Issomething wrong ith my child? Lexplai first UTI needs US and MCUto exclude clearly explained what is Then I quickly draw pictare'of bladder different grade of VUR (Grille I—V), spontaneously, (the mean age for reflux ico-ureteri¢ reflux. Although 1 } She pretended'that she do nit understand that. ".. tiréters, explain that there are five ide T— [iF aré likely to resolve ion 6-7 years) Grade IV less likely AO rea? cas@ antireflux surger and V rarely resolves spontahéously, so i that required. I quickly éxplaindd what surgedn will do (nioi vesi¢al attachment /refiiplabitation), ifn myehlld need surgery do PY tion gh mn everything to:her in ni Look muri, I at that'stage ¥ mote information. Right. O! ‘said, uncomfortable, ioditying abaorm ing abnormal uretero- ry (Gtade V). Thien she said: So isjudgethental way and in.the plain English. I said 7 age Iban only guess, Aftér we do US & MCU, we will get wis MCU: done? Tsaid it is abit, hild will be tatheterised nd contract instilled into the.b! ladder. ied (only oral miduzelam iy But fortunately, general anaesthesia is hot required (o1 ‘ilectdchobgaijat if the VOR is confirmed, her child will until out of nappies or at Jeast 6 months from the last UTI to provent pyelonephritis, renal injury and other complications. Fsaid choiéeis between Co- ‘Trimoxazol and Njtrofurantoin, When Tsaid that, Bxaminer-(a young. doctor, of Chinese descent) said: Are you sure abou! aly 01 ic antibi Tieseline Nitrofurantoin. Yes I replied, and T said that | am quite sure that it was written somewhere, that you can give SA_@ Thontxapin SEQ Bihacrkin (Grrney onto. agian AS shoo gr ghtatiente =v BO ees) Rignd ernest & rqunhoi . a adencergh ed iobloda| LD mipelle , huade she nek @ wack aeNitrofurantoin once at a bedtime. He sai headache, vomiting, and nausea. OK he said giving a Nitrofurantein to an 18 moaths old di hat is SE of Nitrofureatoin? I said oat anyway 1 will be very cautious hid. [seid avcll, before prescribing that { wilt consult paediatrician dnd check dose in the MIMS or AME, because I do not want to harm patieni| aware of Co-Trimox azole SE: thrombocyto: Bell rang, and I left the room. T felt that I said more that was nécessary (ote enia, neutropeniz, fever, rash etc. In addition, I mentioned that am of VUR, reflex surgery-ete). Maybe Examiner did not have those informition in kis seript-so they ask me to clarify what I've said, maybe heis unexperie this station was to test you further, Station 12.4 p. das | Gea - Scenario wes so long, written on full A4-pag: agitated, has auditory-halhucisiation, has pro! gotsiping about him all he timé, He has somal right hand 6 months.ago, now he is OK. Task was to examine his mental state, When T entered the room, Examiner,(middle| lege lady) told me to.talk to him, ced orsimply itwas.a purpose of ere . Patient ig Tet with'a family and yourg:man, wtio is friends, they . Heinjured aranoid'ideas a [He hasa0 pita abides. Gp ig and explain his condition and.management to him: The patient (a bizerré young man) had blue. constantly hitting hiniself in the head with hil trousers, helmet wes on the floor, so I suppo: cautiously started to take psychiatri¢ histo: MAD MASOHIST) .He wasn't so.keen to tal things absolutely not related to-cach other, fi notice weather outside. It was difficult to anc thought. He was not aggressive towards me, ‘What seems to bé probl he ed: ed that he came with e motorbike. I {fom him (emiember mmemonic * all, Well Isaid-to myself, ju talking, bedause'l wasted al Otherwise, Tam not 50! ess Exar family, finance, erid housing problem. I he used Amphetamines 1 asked him about marihuana, iy jot, everyone does that scenario, I asked him explicitly: Do you hav No, he replied. Do you have any thoughts to they all talking about me- he replied, It is hatd to uncooperative patient. Therefore, examiner that { would like to admit hijn.to hospital; by WhariSanihinencikkethtay Hoel keoldtisht}i ambulance. I said that am not going to. that case, I will call Police and ‘give fim Then I mentioned Mental Health Act you know how you will activate Metal ci on-call, Beil rang so T finished this station. eles pred s fins yon nervy ecco + Worn “yews at} paceneet oy . . glaey rr dele gin Deer isin Acute Psych i aeeiphoal consult Psychiatrist. will ealf ambulance. She said: : ont himif fe is.aggressive, and:in Haloperidol IM or LV 5-11 invollintary adm h Act? Tsai Fam not quit (ectually 1 had.no idea about it). Anyway, I seid, 1 will consult any Psychiatr andageon hist right wrist, and fist. He had worn & ripped to me,zetially:he stid afew . any though about killing yontsel®? il or hatm-anyone.. No, although actall information from such tigeHehmnitad?.. ‘He daes.not wanlto.gainto. Omg initially. == ceese. ; She.asked me? Do * oneppeohent con se SPT Skota cory gat (coe Station 13. Pax. ot. S78) bP. 737 Pe - 2p intercostal recession, inspirdtory stridor short history and manage the patient. lew at qi ole f Pepi vender) ctiins 6 Garadt font. pide ies. YI CR RNS : oma vince ge wid) pov drome on po, ae | i ean AS months old baby, had cough, vera C, last night Now baby has AN = 45h, ut not eyanosed. Task was to take Father (role player) asked me what is wrong with the baby. I asked a few things ic; Immunisation/Bleu boo! 5 asked for description of th coug: the history, (when did it sfart? Anylasscciated, symptoms. Cough/Vomiting 2 cough, he said barking . Clue to the diagnosis was straightforward. Tt was CROUP (severe to Laan is Seuthendivh itedesdtshout croup (Patient education)slexplain that child should be admitted to the hospital. Examiner ( older Dr) asked me: What they going to doin the hospital ? Imentioned corticosteroids, nlbulise enaline, warn humid snvitonment, no oxygen (may mask eyanpsis, which is sign of progressive obstruction), observa careful lyon ward. Examiner asked me: What about antiblotics? I said that it is viral. infection] and antibiotics are not indicated unless bacterial infection @, con F gs heme 2 No associated. I finished that station earlier as well. 2 whe me 2-37 ‘Station 24, 9. when de, gor susal| fe tee Hepes Cs) @ fer Hos ky dy Titel bp ol A young woman had swelling in her right/ealf after a long trip. Take history and manage the patient. Peon Aide quasi” It was also straightforward djagnosis of explained condition to thie patient. F recomme: initiate therapy (eparia, Warfarin) and’ Dr, of Indian desceit)'asked ine details abl monitoring (APTT), When &|How tong, (izyabn)p RutriaoBbaihd S redistance, hupi antibodies, Also I mentioned-fhat I will li talked about risk factors, prevention: . [Station 5 eae: 25g § Patient has swollen painful hands joitits. _® wet by de paccesh 2 + Utook history, (FH; CC etc). I faded admission to the hospital; to Wo investigations. Examiner (older it therapy like doses of Heparin, larfarin. The I talke: anticoagulant and anticardiolipin§ Lt ¢ Wwith haematologist etc, Then I @TESBs Od Ort Pie INR D> GP + Wotevive * oS monly sk was to examine his hands. entered the room; patient whs (this time Featpatient, older gentleman of Asian Mv: Lee (Aecent) with Rheumatoid akthn *| complicate, Refer to’ Talley &10°Connor —| swollen & red If MCP joint, Hottonniére, | deformity. oe \On the table were keys, pericil fest (CTS-is common in RA), also looked 1 itis. Hefhad his hands on pillow, Case was not heumatic hand éxathination. He had ‘ay neck, mallet finger, thumb Z coins everything is necessary to do hand wept funetional assessment. I asked him to pinch grip, key grip, grasp, and palmar set 2 'grasp, grip strength, T asked Him to write something, he did that, I did Ph r trigger finger, etc. ExaminerPhe. 2 ——fP1P , cemreal - . RA “oi MmeP, TM) Corveent hor, kres. , 6lengtmorer, (middle aged doctor, I guess orthopaedic surgeon) only asked me what other joints Twould like to examine? said cernest spine, it clbow, weist ( nined already), tarsal, and MTP Joints. Ewas very confident ‘hat T passed this station, at least because thand surgery is pact of my specialty, Station 16. g., pareats. No history taking, | Tiness this station completely, First, when entered the room, father of the child (cole player) was sitting on the‘other side of the table, He asked straightforward: Doc, what is Wrong with my baby? I said, look it could bea few things. He changed expression of his face immediatelyland f knew I said something wrong. Look I said, r Would like to get MOT€ examination findings, like is the heart sound 'ur vaties with posture, is it louder” when supine, which will help me to decide ig ita innoccat murmur OF some organic murmur. He Said there is no furthe; information available. it: actually confused me. So he asked me agai rit might be innocent venous murmur (Still's : harsivhigh pitched). Therefore, Texplained fo him what js VSD and Whatise & P. 42. {teatment. Obviously, he was not happy what I said, Examiner (older fads + TASRIF: Léok you know algorithin fom the book, tell them /draw it is your only chance, I quickly draw dovivon ee /algoritiim from Paediat; Handbook Melbourne and told them that el ‘ough I am sot cardiologist: buf [ know basic principles. OK (role player) sai what you think what is wrong with my baby. I said it is probably janocent mu fur, but I would like to be on safe side of medicine, so I will consult situ Possibility of ECHO (which >° by the way cannot diagnose murmur, Dut Weican exclude other heart defect). think that examiner and role: player reafis that I hesitated about Biving a diagnosis. On the other hand Ichowed them {hat I know approach te heart murmur. Bell rang and examis finished. | Examiners are more than fair, they not fcinste trick you. Ifyou have knowledge and ifyou are bit “off track”, they will Put you back “on track”. - AU the best °er edna WAP ye fh FOr§- ON /poed hav CLINICAL EXAM RECALL APRIL 2004 EXAM - MELBOURNE PAEDIATRICS 06/2 | oy 2 Mnueerifation of clSauat Giaslly levy 1. One year old child with bruising, irritability and fever 38C: He had brane You ordered FBE. It came back: Hb-63, WCC-0.9, Tr-30, no blast cells. Please the mother about your diagnosis and management, The father is currently overseas. Idon't remember about lymphinodes and spleen” My DDx: aplastic anaemia cr leukemia. I said about urgent admission, bone marrow biopsy, steroids, antibiotics and possible blood transfusion. I forgot to say about Tg. I mentioned chemotherapy instead although I don't know if it is used in this age group. The mother asked about hair loss. Then I told her-'o inform the father and ask him to come back. Probably I should have mentioned bone marrow transplantation and that we needed in check the parents if they were suitable donors. tke 2. 5 yeas id child had impetigo 3 weeks ago. He is pssght now with pufly eyes, low urine oxstpuit and desc urine, The task is iu tele the-exer Moation results irom the exactiner and explain Dx, MAX and prognosis to the rather. BP 1407, T s7.8C, hing bases are clear and womaturia.. Questicns asked: 2 Aso. €? che eee ow long should the 10. tay :athe heapica oe yn Wht yt a Te + When would-you like to see him after bis éischatze? 1 JK -“#J) ee upcads agen . y you i ig ent « je te “vores” oe. ¢ Aig will worry you in his Tong tim manegenien? go, pyc (eke ‘t 3. Mother complains that her 2/5 y.o. ch'ic doésn'.‘eat well. No’ azusea, vomiting or diarthea. ‘Tae kid is very playful and active. There are fiotuSre children :n the family age 10 and 12. The height and weight of the boy were given. You should ash: le charts. They were : hidden under the table. The both parameters were; 1! 50t1 percentile, Reassurauce case. I called it “Bassyceatse’. The examiner asked about -he'zeesons-for this condition, The mother we te: asked to refer her to a dietician what Tdid-reempictdarateometidg eel balance preptare prin dei! (dependénee ” OF Geog, feat OBSTETRICS AND GYNAECOLOGY Dane drorietertip Pada mod wrt bbs minn! thas dor agp... StbHx, prevd-seewpe, +R” 4; 26 y.o. woman with right iliac fossa pain’for 6 lours, not on the pill, trying to get pregnant, 1118 1 TNMP 3 weeks ago, no bleeding or discharge. ASK examination findings from the examiner. The patient is in pain but not shocked, suprapubic pain ofi abdominal examination, no cervical vast govt exeitation but right iliac fossa mass. Tell the examiner what investigations you want to order, 2x“ of" ey The results were not given. Advise the patient about the Dx and management. My DDx: si ectopic pregnancy, twisted ovarian cyst or twisted ovary. The patient asked about the impact Oo? omher fulure pregnancies. sou tay how 4 Newel PRY, Lok Nioiwe Mp ectepa sa Trina Pag. Miu. Fer A389. GP theta awn) zy , dvalgeorg .couobgiet toda, 2:26 weeks pregnant is present Tr her regular check-up. Two weeks ago FH was 26 and # today FH is 40 om. No complains, she is Rirt, GPT normal, US at 18 weeks was normal. 204 [S* US is done today. There is a large amount of amniotic [huid and smth wrong with the bab: @t*Y admitted her because she lived 30 km from the hospital. The pulival esked about the delivery gertte ttle 1//et (D BMT exoyctsgr, ROAM abis peda ys * tlaemon vg lalery deg V-3018y.0. gin with primary aisSGSHAe® “All secondary sexual sighs have been present for 3, years. FHx of pubertal delay. Mother had menarche at the age of 17.4 régutay abs prew'y P.O nndSURGERY att og xe bers Tho result came back as SCC. Further management. The patient asked about the types of skin cancer, tion and her risk to ha inthe future, G2) “le chaye Colne De, Plann ce ge Aa be Tsk TERS pe Same ts fans Sed ae ote nate. 263 ssi8@aj2. 57 ¥.0 with diverticulosis and FIx of bowel cancer. Her father had bowel cancer removed Sau sept the age of 65. Colonoscopy was done. Explain the condition, possible complications and ae Sereching, The examiner asked if FOBT is suitable for the patient with diverticulosis. She asked about the risk to her 50 y.0. brother and 30y.0,son. She ins 2 beer a day. The i is. D0 Blvtn 2) ante vty Kaplnes conta Th costal om, Sea ea eee Oe eee ie di eg aan Plano rene bt con pagent ade * DIN Nuh Sint dher «Tate us Ga Sonaenly weed weal» 3. 12 y.o child with supracondilar fracture. ‘The mother asked if the reposition of he Sane’? . Sik ould be under GA and when Twoulg ie to geo then) again. She asked aboat long ten 7 @¥ complicétions aswell. beck stesy bebe So ene ments WED Heber Mee, 2 set woken. a thie ROW )Ae li j RI lane arg cust 3B ee aes tS ce ee ree ee SE oats 8 cob ER SIN Phyeo: . . : newt 1 Lower lia ek “uninetion ia the patient ‘with long stancing poorly cdniralled aiaictes as s éfetey emplanations whet you are looking ior. ie was peripherl neizopathy. Beane pret ona 4 bone * eau Sra nego pra tee is aud ainohol ebuse with comments. It was 5 SENS, Sodio Mee Koes! hepatomegaly ( (uae ‘Hines’ ei 3226 y.0.-with hypertension on the pill, Wouits 19 starr bier family. Asked about risks to her Oo LP fey “ pregnancy and BP conttol during’ tae pre Ble uae Hot, setae: we eS Sven, =) sedeooee. i, gee Uset Say stabs fang ban Nips 26a ahi alee NEES St Nisre, : au . 3 “bs. 8% Pres ye. fav ShSker with SOB for'3 weeks. History taking station, Younced to ‘differentiate between cardiac and lung causes. it was pleural effusion on the right. Give 7c hest Pats ; Pl Possible causes.for that and future management. Seta wer pu dats MS hte ryt patina Osa FRE its, LE Bie. SPabyteneg arg Fev rlytg same) nest tb eer din, SPNBIS in the patient with hae hepatomegaly and splenomegaly: EG. Git: CvSebIn > beonehoscorns y/ 4, TATA oe Rete cls LU i m4 pos Oebeacsion prrececanig, SEER Em SE tens Ques Oeatn mares 7 X Young girl who hasn't been sleeping for 3 weeks. She asks the parents to buy a ticket to her mental state after that. MIE Q 1H thou othery Pin Fag dg 8d Hye batelng ¢ PIM Bhp Mo ~/ 2. Alcohol abuse, 30 y.o, single father present after being seen in casualty after traume to the head. Take alcohol history and advise. The patient denies everything. > se (Ftsts commbrcs:bale Wettbdlrens treme.BD ANAND Mowe ‘0: Mr Alan Robet From: Priyanath Reghunath oar20m¢ 13:5004 pag, ‘Sent by the Award Winning Cheyenne Bitware AMC CLINICAL EXAMINATION CASES APRIL 2004 1 26 yts old lady was diagnosed with high biood pressure at Red Gross. She gotit Checked by a doctor on the same day a few hours after which was high again, She had RFF, 8. Lipids, LFT, Abdominal USG which were all normal Today she has come to your clinic & the nurse checked her BP which is 101105, Tasks; jake a relevant history & advise her tegarcing the management Patient didn have any symptoms of end organ damage. She has been on OCP for a few years. 2 S5yrs old! man comes to you with recent onset of breathlessness, (2 weeks). He does office job in a timber shop. Tasks: Take a relevant history. Ask the examiner for examination findings, Discuss your did & management withthe pt. Answer the questions from the examiner {Be cle smoker 20 cig pe day since young age, Dyspnea is mainly on exetion. No dyspnoea at rest. No orlhopnoea. No PND. Father hag Emphysema, Pthad pleural effusion. Examiner asked whal specific investigation will you in this pt? . 3 S0years old pt atiends your Op with cfo mild hemetemesis Had similar clo a few es: & months ago for which he was admitted in hospital. Endoscopy revealed Cx 12hrs ago which was bloody diarrhea. Past h/o of angina, GORD. No previous similer pain. Paticnt was really in distress and required pain relief before further history was _- om poptodhs. possible, OPeows+A8e 02. Gormulees ree Se LET Arey se fleck Eke cx ARS No NA On Bx. Temp-39.5te, Bp 150/90mmbg, Pulse HOt REX nad PAT Tender allover, ne occasional bowel sounds & tender to percussion all over, no organomegaly. edt Tkept a Diagnosis of perforation, Diverticulitis & obstruction é& managed it as such. 2 / masa This was the famous case of 25yr old brought in a coma'by flat mate who is new does not know much about the patient, The task was to assess the conscious state explaining to the examiner what you are doing and your interpretation of it. Since 8 minutes is too long for only GCScore, I was able to finish ABCDExposure as well and give my differential diagnosis. Some candidates elicited Kerning’s and neck stiffness and claimed it was a case cf meningitis but I had a GCS of 12,, although I considered meningitis in differential I did say Keming’s would not give me much information at this GCS. Be smooth & quick in exemining. They had cotton wool & pin prick available ABE DE CHP which some candidates used but I did not think I would get any information with CNS . toes depression & said so. GCS assesment Minky Chock Hines Mody magus. hh PPA COM A. SFr UH LETs aug paral tohlattaltgse Tea CXR Etly, nv ress, Q3f XRay of Pneumothorax. Quality was very bad, reduced onto A4 size than printed ono vend xi paper and laminated on top, trachea not clearly visible- forget being able to see any Siepega deviations of it, was very difficult to make any measurements however, lung margins us Gindlesoak collapsed was clearly visible. However, it was pneumothorax on the borderline of ote * conservative management or not. Male patient with sudden onset of severe chest pain’and eee no shortness of breath was in front of me. I had to manage the patient and explain why it g enacts happens to the patient, This was my last station and I could not care less so [actually did “te so) conservative management because I said since you have been to the X-Ray department @ 0 Gnprom without further progression of chest symptoms -4 did take a shoxt h/o to confirm nee Gat apa oe : tt aaypeetcate, huyptens th Subpla: diagnosis, Nevertheless, I oe do a great explanation of what it 8 Patent pence: pee hook ith 24, This was 67¢ old with fever, perioral pallor, membranous pharyngitis, sandpaper v7 th on the upper trunk, whiGi was palpable. Task was to explain the diagnosis ni management to the mother. I think it was Searlet fever and managed it as such including swabs & ASO titers. Counseling skills must be perfect as simulated patient do ask real life concetus, which you should be able to answer, dacs. aled vanityofé', OF Acute urinary zetention in 48yr female wiih no significant past history. I think not N . ti ig @ catheter in the first few minutes was a critical error as patient was distressed and history taking was ineffective and the examiner smiled when I said I‘d puta catheter »¢hrol, cusry & before continuing my history. On vaginal examination she had a taken up, non-mobile = Herpes. .wp Fa cervix but had a definite pouch of Douglas mass on recto-vaginal examination. had to 3) « phe ood, explain possible diagnosis as Ca tntil ruled out and ultrasound with gynae referral. f, : Femowd => OF ebign eg - eo dregs msalared Qiphis was a 25yr old primigravida @ 30weeks in rural hospital presents with leaking : PV. Take further focused history, ask examination findings and explain management to patient. This was PROMembrane confirmed by Fernings test. 'ransferted to tertiary + centre and did the usual counseling as onset labor, fetal monitoring, preterm baby, social ‘supports etc. AF gee om sd-2 OF" This was 25yr old newly diagnosed hypertensive, recently fully investigated with no. “1 plov Sidings al work and bad sone risk factors, Task wae management and counseling of © newly diagnosed hypertensive. ©¢ p hduced HT. @ Q§- Anorexia Nervosa- was first presentation, brought in by mother; who is concerned; paticnt had no insight but was also dehydrated 10%, Task was further focused history, diagnosis & management, QY This was to do'a Mental State examination of Acutely Psychotic Patient in six mins and to tell your differential diagnosis & interpretation to the examiner in 2 minutes. QL 9- Low Back Pain & the task was to examine the back, giving a commentary to the exaininer explaining what you are doing and Why S@)eH COQ) .-> exe-—atnadton ate» OLJ- Knee pain, Started 6 months ago with lifting heavy weight. At that, time was swollen. Task was to examine the knee explaining what you are doing and explain your differentials diagnosis. I was expected to be able to say which ligament or meniscus it Could be but in absence of findings, I could not say so but I was able to show my examination technique. e : ay Sb phe the ch. P our ‘Task was counseling the mother of a very Sick child who had possible meningitis; ne¥ded to take focused history and explain management and possible prognosis é& complications to the mother. comp! sae er. He TT coh penny ine. our proh. hendeela, ° Fading Ok. vite lpeay amination. RISES FR tang dephasing MET sly fea adel OM EE DeBna he al Cree ld Ap muh meet oer A adluadt G9 Ab, wld. B/e. SK e Com iy hemenmp CDMS, fet Henny early teaches de weuat. priwat > erabeet Supp b haaters FR Aape iQU3- This was an elderly male with frequenc f urine. Taskewas to tak further focused protthistory, ask Gkamination findings diagnose & the patient. Although this was a %_gase of Diabetes Mellitus with Obesity, Suioking, hs dad died of prostrate Ca @ S0yrs of ] 38¢ Guled out with PR NAD). One thing I specifically remember about this question was thatthe question asked, "You may ask for patient prafile if you need”'rl could not realy understand what profile meant but assumed it some social history that I took and ended ~ Pv bleeds oe : This was ami forties woman with BUA but of history lad not ha apap emene ‘or Mayr; bleeding since coitus recently. PSp. Large ulcer posterior vaginal well cervix. Needed urgent colposcopy and required breaking bad uews as possible eaacer ts with history of bilateral pedal edema- non-pitting, non-tender, totally resolves in fhe moming, Past b/o stopped playing tennis due to SOB during the game but so other SBmplons of heart failure, Most history aud examination was NAD. Nevertheless, ability 10 consider causes of bilateral pedal edema and rule them out with history and examination before saying it was dependent edema was expected. Je Oy Tis was very broad based problem solving, Elderly woman currently on bus tour 2 P QIG6- Child with nocnimal dry cough, positive family history of asthma, father who smoke albeit outside the house, Required Asthma counseling including use and care of ‘spacer and asthma prophylaxis. . In retrospect, the exam was tough but okay BEST OF LUCK> Devina Singh. - ams ss\zI g April 2004 AMC Clinical Exam Recall LE Polyhydramanios ‘+ Pregnant lady 26 weeks AOG feeling exhausted comes to your surgery located 100 km away from the nearest hospital. ‘Task: Relevant history and examination, investigation and management ‘OCP- induced hypertension (old recall) lady detected to have high blood pressure when donating blood. : Task: History, diagnosis and musagement 93-°2.5 year old child who has lost appetite Task: history and management “Examination of the diabetic lower limb “5. Patient with delusion, He wants to go to the US to inform President Bush on the imminent attack on the USA. Task: Do the mental state examination and make the diagnosis ‘Alcoholic patient who denies his drinking problem » Task: Management <2 year old child with pancytopenia * Task: Discuss management with the mother and explain differential diagnosis 8. 11 year old girl with a fractured elbow * Task: Read the x-ray and discuss the management \9 Post streptococcal glomeralonephritis © Task: Discuss management 10! 18 year old with amenorrhea ° Task: Get history, make diagnosis, discuss management -AaPlease examine patient with recent homatemesie: The patient is a long term Ano otoslcerostc. bene try inner EAC 1S replaud§ — IntScho — Glue alcoholic. . = Task: Do targeted examination of the GIT and report your findings. NIE old case of ectopic pregnancy. © Task: You have to arrive at that diagnosis before obiaining the history and physical examination ot requesting relevant investigation in a patient with tight iliac fossa pain. : Pregnancy induced otosclerosis. * You have to perform the relevant examination after a I minute history. Make diagnosis and management A case of shortness of breath. . * Task: Obtain history. Ask for relevant examination findings and investigations we and explain management. Dx; pleural effusion . Case of diverticulosis. * Task; Do and explain the management. 16. Case of squamous cell CA with previous biopsy wherein inadequate tissue sample was taken and biopsy has tu be done again. © Task: Counsel the patient and explain further. ‘munayement. . Hes emet— SuidenZor qred. gating Wore how long Saddam after showering Ply ob bene’, pra, chs oxteraa or meds aK, SMP ~ heise, . way Hx alco ha SED inesliyereides diuretic, chemoih, Salirytates. ue by Vakctadine, Veh Site, divin Tiemthis —reniere’s Spon bone, Bie teavel heed wytry . atcoct (Veetge> ebhes tees e nemces [Six Caterina dorminewabs — esam o Mow ma ; Clinical Exam Re-Test Sydney 1 May 2004 _ SNonezatian © ~~ rs “35 ylo female, 6 wks amenorthoea, pregnancy test +ve, severely vomiting, can not retain anything neither solid nor liquid She saw her gynaecologist and he confirmed that everything was OK she came to see you as you are her GP, Urine shows 4+ Ketone. Task : Take Hx, Ex[x & Mx ; ‘After ing te estrus om the examine I approached the pte nd introdoed myself . ; ME: Jeane ono it ou aren is your est rea? PT : Yes ME Congratulations, how the pregnancy was confirmed ? PT. : By blood test’. ME:: You are severely vomiting, how oftea are you vomiting? ” PT : 1am vomiting as soon as I eat or drink. lam worried I will die itis condition _«: does not stop immediately ** J tumed towards the examiner and fold him that I want to exaidhine the pt JEX: What do-you want to examiue ? L ‘ME§: Vital sign-—-P BP RESP 'T all are normal General appearance—Looks unwell . . i ope Orientation —-—-~ Oriented . gals at Storhoblethe abe Tet ~ probit. pray, Investigation : FBC, UEC, LET. UTUS,BSL-not raised got beds cy I tumed towards the patient and said, From Hx Ex é& [x it is evident that you are_ 2 wle severely dehydrated and the condition you have developed called Hyperemesis e-Re Gravidarum with ketoacidosis. You need to be hospitalised where they will correct’ a, 14 oubyyer your dehydration by IV.fiuld and gradually vomiting will also sattle down, [ also” Te Hee mentioned that this condition is called “ Hyperemesis gvavidarum” It is aot dangerous but if mother is dehydrated then can cause some problem such as convulsion PT: How long this vomiting will continue? It should settle down next 2/3 wks PT: — Iwill die in 3 wks. I am worried for my babySYATION F 72E 2 § ook Wont die in hosp they will give some nutrition inthe saline and asome os » medication to control vomitir ig realised that you are very much worried about your" ae baby, but Tam assuring you tat this Vomiting will not affect your baby. PT : Wil that medication affect my baby? . ME :No . pit talked few wards about antenatal sereenig of Bewniesynand pregnancy induced DM &Hypertension . — Letveroplanede 2 ‘ — Ser GE Git bead. — Gastric wok dihy ~ Sbsinctiay* © YE Restessiness - Pascoe, « Partorestion rowsimes - Hleadooive Precchionsed'ts For "Tardive dyseinosicn hip oyien basitde wt 4% “open ¥ . MK. Tv Slisicls a Cheers BSL : i “og. Katgohlep rangle ir i 2.MST oe oe SV Theiaune in. drip. Woda’, emuephetpalny edit by poyptal Ch prank aur’ dope) = Weer tk SY dbhuig mow y Honfononn: — solubur. ‘ € 4 Shale Antone + 2 > men cantina 3-4 flog, all comer oa. Hy wltod i “gue ! EO thot . Che Ome. — atoms tale suger, apne, gw usec, etlong : = Melpelapenodt. / Prometany MeL ' : woonit, eon ong = dado, 2 dey ofr 4 cnt she sped ebAMC CuinicaL, EXAMINATION RECALL Sypney, 1° May 2004 Hip exam on a young man. Breast cyst, explain to patient and Mx. Fatigne, a lady was depressed actually, Hx taking, Dx and Mx. Diarrhoea in a 47 yrman, Hx, Dx. SIDS, address to relatives on a family meeting. Mx. only ato ws doctors Migrain in a lady, CT brain normal. Mx : ‘Carpal tunnel syndrome, Hx, Exam and Mx. x Urinary incontinence, Hx, Dx and Mx, Acute psychiatic of 25 yr young man, talk to mother. Reual stone, Dx and Mx. 2yr old ear infection, T38.6. Talk to father re Mx. 9 yr girl moved in your remote area with Type 1 DM. Mx [Lunf function test, explain to pt (COPD), advise of how fo use spacer. Claudication in middle aged man, Exam, Tx and Mx, 41 weeks gestation, rupture of membence, Mx 16., 34week gestation, small for age, Hx, Ix and Mx. Scone yb ode bok rok yaegY, Male nutte, 35 yrs old had sore p “ skin and dari€ urine since yesterday. . . = Glanoy Task: ... Také televant history and give D/D With possible causes of jaundice Vy Do hand examination and give your commentary as to What you are looking for. She ‘Was a real pt with osteoarthritis, o : Teport given by geneti¢ depariitient regarding Syndrome. She is 30 yrs old and has advised by Genetic. * ~~ How can Treaties ie7—— 5 . . Trill Dinow in advance, if Tam having child with Down symdsoine? pT esYe Pom symdorc in my nek regan, wat tons fo Ee? * ea poe Seen Dil yesterday Bt eo yo has dexcloped 5 Tage Box ath She is enquiring regarding ber exposureto chicees vce . Task: ‘Take relevant histéty and answer patient's questions, PO dye ae wane in een ask: Take relevant history and give provisional Gagnosis (patient had unprotected Sex for thirst fe 2 i ae et Hating Som he examjacr Tt was a case of herpes’ génitalis (tall about protection and sseurtence) _> ro Jy P Agitated parents of five months old baby haive'coisie with fointit So @n J ecatl period). Mother was angry on tang iequent of os weak ep better method of treatinent, On ear examination, findings Were red bulging D.GEA> tympanic membrane with pss collection. On throat examination, tonsils slightly galarged and adenoids.normal. ao an i, Task: Discuss médical and surgical fteatment of suppurative ottisainedia, : &P. Four yr old béy complaining + (of fever since 4 days and progressively developing limp. tniez, “Tasks. Take relevant history, ask for relevant examinati oH. examiner. Give your ‘Provisional didynoses. Tel Cuay9y Young man, a kndwin stnoker, Ceinplaining of eautisaton ais leon walking 200 e metre, n Pe fT .injuties are there, It ws 02g with whsar nerve involvement planing © last one hour: But now Task: Do releys ee . » Oly 2 Yur Provisional diagnosis:and SiS Itwas a case of thyrotoxicosis. Vv oe or . Forty yeai‘old lady bas been diagnosed on FNA result : ductal carci Som her ight breast for invasive Paski -Beplaif to patiebé as to what it means ‘What will be the management and’ * follow up? * 8 so . Se shay teats with patient aboit te treaimedit, . ° other drugs if you sop haldperidoi - Wvahve begat Qa iy mmolig ne cool- Cpt theak A hack Sys'k a, mk ek wivaded tay boitment “Andean, L vfs oe ae ~ ole £ offen recdlicaanbent C Sushma fi: TOG OY econ S98 whens EXO GW Ot SE Nery Ce) be : Ge oS be & L6-477. wv breol cole ted + Counsell, wodeC 5 2 toss . .Fe Mon Whe > A day rhe T Bly olactdty 4s tebe 4/b. ADELAIDE MAY 29"4,2004 - CLINICAL EXAM RECALL Paediatrics: 1. An 8 yo gid brought in by mum for 2/7 Hx of sore throat, now rash on upper bo: , gece ou Chex Hill) . OVE T 38-59 Celsius. You're a GP, Manage, W757 “U8 CRY Sars ee Koes My Dx Meningitis. gave a shot of AB, called the ambos and send to Hospital " after | explained to mum my concerns. Q's asked: Complications 4f meningitis, what antibiotic. N.B. Be empathic, concemed, cool calm and collected, Don’t forget to treat contacts, inform school and Health Dept. I ers wth, 2 Be Seth ign Emergency Dept. A 4H2 old baby brought in by anxious mother to hospital for few hours of becoming drowsy, not eating and « drinking well, and no wet nappies for quite few hours. Ask examiner relevant physical exam- baby DROWSY temp 39.4, “BLOTCHYEmettled hands, 5% dehydration, slightly red throat and ear membranes. ‘ . I kept the child in hospital, di is and hydrate. oan tage Pan . a PEERS relay SO sarly Went, 3. Asthma in 2 yo gir presents with just nactumal cough. "2% Obstetrics and Gynaecoloay 4. «’A primigrav 30/40 PROM in a country hospital. Just read it and know all about it, REASURRANCE IS ESSENTIAL as the woman wouldi't bloody setile! Magic words: TRANSFER to tertiary hosp. 5, ‘Gervieal Ga +/- vaginal extension in a 40vish yowidower. PW with es te nent. metrorrhagia, postcoital bleeding and last PAP smear (when u ask, as. body is gonna feed infolDurrr!) was 14 y ago.(I actually couldn't help con nol g ay Os whan.” Tone express my shock, but then I fixed it with a smile and a “Oooh, that's not very oad, is it?"), Dx, Ix, Mx, explain to pt. . The speculum examination revealed a tim reading thing.| swear | couldn't understand English anymore, Alt] gatherad is there was an ulceration at the Junction and extending up to my brains at that point. NB The pt keep asking if it’s coz she had sex 1* time in 2 years since her hubby died. Fm not sure, but it can be a trick, Le. guilt, so be careful how u handle it. said that the fact that the bleeding started postcoital indicates some sort of pathology to me, but didn't get too much into it. 6. Acute urinary retention in a 32 yo terribly difficult and non helpful female(of course) examiner. | thought that { had all my gynae cases by then, so | thought ARF or some medical thing, then started to think surgically and in the. end the bimanual palpation revealed findings needed to be read in another 1 - min by the other non-helpful examiner. Itwas a bloody mass obstructing ‘somewhere, The hint was given when | was caught andfvas sure that | failed the station. The pt asked me if she will need an operation. ‘Surgery and Medicine7. Knee examination. Itwas a medial meniscus injury and the chap was @ rower (Thad the examiner showing me what that was as | couldn't understand the Adelaide accent, I tought he said a ROARER!!). Anyway, read this from Murtagh, itis very good there, I1r/fed him to Sport Med. Examiner asked me ‘what would the sport medicine spec. do- mention surgery. . Acute abdo, No results provided but make sure u pay attention to that poor pt idid ;-) y 9. Spontaneous pneumothorax. Read the CXR(was a crapy picture), explain to the pt, and the examiner further MX. Q's asked: what is it, what is the +2 hrs, percentage on XR,how to treat it, what's the recurrence rate, Rx of this(didn't know [had the word PLEURODES!S in my vocabulary end knew how it, foo!!!) brget, sur 2B Bef, oe side, 10], ets Gmakie, pothn , th, 10, Sciatica- examination and Dx. / 11. Unconscious pt no Hx available. Assess degree of consciousness trying to find possible causes, ask Ix (no results given). GCS was 9 (please make sure to know how to do itt!) and Kernig/Brudzinsky +, ~ but u need to rule out other causes. This was the most unhelpful, hostile and utterly intimidating examiner. Bugger! vy 12, OCP induced HT. in 2.50 y o lady. Take Hx, Exam,tx,Dx.,Mx. Some ectopics on SOK when taking Hx, | rited to Cargio and told her what they! 90. ehh. Nay REY, ask SP HF oon a sane to has 1 40 eras, 44. Polyuria and nocturia in a 60 y o man with no PHx, FHx Fa had prostate eo Uning « v That was my first station and probably failed it, as | was convinced that 8 min takes forever and that the guy had Prostar problems. ! got at the Dx when the bell was nnging- was NIDDM. Very pas tat Rta prObs- Oak @ uf prestete Maite Ps ate SE . rl probleme 2featins, dante, Malate ~_15. Anorexia- beautiful case- all the symptoms, amenorrhoea, BMI 14 BR awit, ‘2M dropping, body dysmorphic features, insightless. BP 100/50 or so, PR se 5a/min. Pt dizzy and lethargic. Guys, if u want to pass this station u have to. ‘ADMIT this chick and ask SUICIDALITYIPIus DDx, ete. kde smagzinesd0v's probe. 48. Acute psychotic episode in a 50 y o lady who was volunteering her symptoms. Had auditory hallucinations with derogatory content, ideas of reference from TV and radio, fiat affect. f 713. Swoallsh afAMC CLINICAL EXAMINATION RECALL MELBOURNE, May 2004 OBSTETRICS & GYNAECOLOGY 1 I started with the station where a woman comes with 20 weeks gestation after her 5 yr ‘old son was diagnosed to have chicken pox he had developed the rash the previous day. Basically they wanted to hear that you would VZV IMMUNOGLOBULIN I wasn’t sureif A 24 giving I after 4-5 days infection as of any use. Please do check that. 2. Am 18 yr old girl comes with acute urinary retention and you are in the emergency as a medical officer. She also had a vesiculopapular rash on her external genitalia and also some foul smelling discharge. Task was to take relevant history for 3 mins and, take the clinical findings fiom the examiner and discuss your management with the patient Ans: Herpes simplex infn, asking history of unprotected sex, mentioning the administration of Acyclovir and telling her that while discharging you would tell her about safe sex and discuss . contraception and doing a complete STD screen. 3. 18year ola ballet daticer with history of amenorthea. Take a relevant history for 6mins - and then ask the examiner for relevant findings on physical examination. Outline you x ‘management for this patient who already has her hormonal levels done LH increased FSH. a LOW,OESTRADIOL 40 mmol (low). Was a case of anorexia nervosa with tigorous exercise. telling what would happen if she had amenormnea for along time they wanted to hear osteoporosis due to low oestrogen. eh posers I Hepsi Pow LHS ppg PAEDIATRICS fee 4, Ayrold boy brought in by the mom with a history of developing fever over the past 4 days associated with pain in the right leg just below the knee. The boy had progressively developed a limp. Task was to take a brief relevant history from the mother and ask for the relovant clinical findings from the examiner and discuss the management with the mother. ‘Ans: it was a straightforward case of osteomyelitis, explaining the diagnosis to the mother and advising admission and treatment options with themother. Rph= 4, “= Spathbabseses 5. AS yrs old child with recurrent otitis media ~was treated with amoxycillin by your colleague .The child had ear ache 3 times in 6 weeks .The child also had and mouth Adare breathing history. So his mother comes to you with another relapse. O/E tympanic membrane was bulging and red, child was febrile. Mother wanted to know alternative treatments, surgeries and medications. No further history or examination findings needed. Advise the mother about the treatment options. . hols. prwigehows y Hep Hudny MEDICINE 6. 54 yr old woman comes with a history of wealmess in her right hand for the past 1 hr and associated with impaired speech must have been dysarthria. While waiting in the surgery to see you she improves gradually. Task is to examine the relevant systems and tell the examiner what investigations you would like to do and also what is the aetiology for TIA. FRE ~ Vromboeg le ante ‘Gasp fells qT Cre cag hack ECG One CF Brat Che Gueo! at ype,Page ua vivey WH scam, UenupaniNnsy 8. AS4 year old woman has undergone hip replacement surgery and you are the intern.you are called as she now complains of shortness of breath and palpitations. She was on 5000units of heparin ‘b.d you are called by the nurse to manage her. Take a relevant history for 3 mins ,ask the examiner for the clinical findings.Tell the examiner what investigations you would order and tell the patient what is wrong and how you intend managing her. 9. Areal patient with osteoarthritis so was asked to do the examination o the hands we are expected to talk as we examine the tell the examiner in the end of your diagnosis. SURGERY 10. 48 YEAR old woman with complains of being very nervous.take a relevant history for 3 mins and ask the examiner for the relevant examination findings .then answer the questions that he may ask. Was a case of thyrotoxicosis. 11. Man with a laceration on the ulnar part of his wrist. Had to examine for the vascular, neurological, and tendon injuries. same as the question that has appeared so many times in the past. ‘There was a bandage on his wrist that you were not supposed to open. 12. _A.48 yr old man who hes been a smoker for the past 30 years present to your GP clinic complaining of pain in his sight calf. Do a relevant examination and describe what you are doin as you go to the examiner. What investigations would yon order for this patient. Rule out DVT, TAO. 13, 39 year old woman has been diagnosed to have had a lump in her breast.She has undergone biopsy of the lesion and the reports have come back as DUCTAL CARCINOMA IN SITU. Explain to the patient what this means, tell ber you will be referring her to the breast surgeon and what he is '- going to do in terms of surgery. hint she then asked about what other treatment after the surgery and &, also wanted to know about chemotherapy and its side-effects. No history could be taken from the 8 patient so it was just a management station. PSYCHIATRY 14. A policewoman has been sent to your clinic by the department as she seems to miss the first day after every new roster. take a relevant history for the first 5 mnins and tell at least 3 DD to the examiner and answer the questions that the cxaminer may ask. Hint-was to take a [past history of an. accident that she had witnessed 6 months ago-when all the problems had started and-aiso an alcohol history. 15. 45-year-old woman who was diagnosed to have schizophrenia has been on haloperidol for the past 3 years. She ahs now come with complains to you of twitching in her tongue. take a relevant history and give the examiner the differential diagnosis and outline your management. Refer basically refer after ensuring safety. Examiner may ask what the psychiatrist may give her. Thave forgotten the 16th one. Will mail as soon as I remember it. Please do not hesitate to contact me about anything, All the very best to u all Love RoopaPred -v pepented / / 2 ora / : . . . ao ADELAIDE MAY 29.2004-06.01 : , " GLINICAL EXAM RECALL Paediatrics: ° Y 4n Sy 2 girl grought by mom for 2/7 Hx of sore throat, now rash on Upper body: O/E T 38-39 Celsius. Youre a GP. Manage. . . My io etna. T gove a shot of AB, called the anbes and send te Hospital after Texplained to mom my concerns, is just an URTE but E need to exclude meningiti(l coutint beers ingitis in the exam, so I felt fixatedlll) so Examiner said "Nope. all your seniors "said bugger and kept the child in hospital, did bloods and hydrate, keep on man’s fp, all that crap(C was'a poet and dides kerow itt) mts 3. Asthma ina 2 yo girl Presents with just nocturnal cough. Good old Uais (aka Wes G4) Mohamed) as T mentioned leaflets and websitelliHal Obs and Gynee t/ A primigray 30/40 PROM in a 1ospit | Just read it and know all about . it, ReAsunnanice Is ESSENTTAL as the woman nwo Deed get ast fort arebso words: TRANSFER to tertiary hosp, > fete 4 ASG dost . uo 8/ Yervica) Ca +/- vaginal extension ina 40-ish y 0 widower. P/W with PER. Actitch bs, dilgehvctmiasy 5 ‘mists e9/ metrorshagia, postcaital bleeding and last PAP smear (when w ask, as nobody is . “ “ gonna feed infolDurrrr!) was 14 y 990. actisally couldt't help express amy shock, but then I fixed it with a smile and a "ooh, that's not very good, is it?"). Dx, Ix, Mx, explain to extending up t¢ my brains uf that point. NB The pt keep asking if it's coz she had sex 1" time in 2 years since her hubby ied Tm not sure, but it con be a tick, ie. uit, so be careful hove handle it, T said ‘that the fact that the bleeding started postcoital indicates some sort of pathology to me, but didn't get too much into it, » 6/ Acute wvinary retention in a32 y 0 terribly dificult ond non helpful female(of course) examiner. I thought that Z hed all my gynae cases ‘by hen, 50 T thought ARF or some medical thing, then started to ‘think surgically and in the end the bimanual palpation revealed finciings needed to be read in enother't min By theGres > mony 87 hess So (otea eet «5 pengil prendre nda'lbed aad other non-helpful examiner, Tt was a bloody mass obstructing somewhere. The hint was given when-I was caught and was sure that I failed the station. The pt asked me if she witl need arroperation, . Surgery and Medicine, Uf Kites examination. Zt was a medial meniscus injury and the chep was a rower (TE. had the examiner showing me what that was as T couldn't understond the Adielaide accent, I tought he said a ROARERII) Anyway, read this from Murtagh, itis vety good there. I r/f-ed him to Sport Med, Examiner asked me what wauld tthe sport medicine’ spec. do- mention surgery. 8. Acute abdo, No results provided but make sure u pay attention to that poor pt. I did) . 9. Spontaneous pneumothorax. Read the CXR(was a erapy picture), explain to the . pt. and the examiner further MX. Q's asked: what is it, what is ‘the percentage hi ‘p2em. on XR how to treat it, what's the recurrence raté, Rx oF this(didn't know T had *iymiprersd. the word PLEURODESIS in my vocabulary and knew how fo do it, tooll) : 49. Sciatica- examination and Dx. ened sphhcter- 11, Unconscious pt no Hx available: Assess degree of consciousness trying to fined possible causes, ask Ix (no results given). SCS was 9 (please make sure to know how te do iti) and Kernig/Brudzinsky «, but ut heed to rule aut other causes. This was the most unhelpful, hostile and utterly intimidating examiner. Bugger! Ages 12, OCP induced HT. ' £3. ‘Swollen ankle in a 50 y 0 lady, Take: Hx, Exem,Ix.Dx.Mx, Some ectopics'on ECG Se HEP and SOBOE when rat in Tr/fred to Cardio and told her what they! do. Ajseriiar. o-ariems 4, Polyuria and nocturia ina 60 y o man with no PHx, FHx Fa had prostate Ca, That was my first station and probably failed it, as T was convinced that 8 min takes: forever and that ‘the guy had prostatic problems. I got at the Dx when the bell . Was ringing-was NIDDM. Very nasty. DA armen wr, TAR He Odo Beat - do y wasn ie Reve A22 Wp hens yr han ee te vse terete Mt (evans . 2 Strésa, Stvely or wrk > ap redo lon, An. a hs me ese : Eitees cea sv Fa Md : aed? en 15, Anorexia BeautitGl asec all She apmthents ancnertoee Bik 14 and dropping, body dysmorphic features, insightless. 8 100/50 or 50, PR 59/min. Pt dizzy and peat lethargic, Guys, if u want to pass this station whaye to ADMIT this chick and ask . SUICIDALITYIPIus DDx, etc. . : . 46. Acute psychotic episode in a 50 y’0 lady who was volunteering her symptoms. Had ‘auditory hallucinations with derogatory content, ideas of reference from TV and radio, flat affect..WS& “DD Te MSE Lik 1 Heeadin Brtrtie, Bes hawt gio. heiy deel ot het dons Mand be Uke yond’ poor ie 88 Yee Meer soles. poopim pene bite nome tran PRIS hae gor, Laut poupte te Nag, Da, adle sents wrOa7 ode yn. Oa Dhan we conc a, Deen gee : HEAL NWS howit dct hale Ihe 4D Banee, akee peau y veer Mf gous nwett omoke ih eteema @ whet dla gyou ttt hs Mo peng, Se Reed HERE O@iraterss as nsicg ane D- Neen Weed dau Jorn. hone mattnt Bp sree piydin Se deapinne haren Alida abide Oarey ade Aheh Woy eertdy cea gon ss goute,Corte 4. Compal Himmel g. 0 yom fel ey ping 4 mtertle, feted 2 Tr tseh ingen da aga Joel 2 Cob, tna, polly 3 sing) Pees TE pring heed abil AF mere er) ly cheukdey DR gam wmka ay ad mrghh dor fo palin 2 pine Lp Whob i yee orinspocton 2 Compt dinger + vert matty, 7M BO bay = Pretest Werle , muh Wrebene Gaalel youn nf % Deen yome perm ane Mgtilerely, ? ou frie Ye leben srtrubmechites 7 Ik i snore tone b Pour tap A & Ais nae ‘Besrmetanyh ton koe Tiinells Fok mantra oe flexed peers typ medianfy ab flocoe fore cen josh Uetewnd fy patra’ lavagas Gas clewndom » sy pemarctian ab deabrtbainthen g msisin/al - Phalen eof . Pralen SoN yingeo peink) Swe anasto baths homieds de SEL dane fs i abner Alergy ‘M wabrtek form meaner, EMSA ae gr > lesb ps prosionee ene Hy Bploan* ( ( Hin podnjene dnerslir Q hemndk counaes! 1 dannel a weist. a we ettast Sa Za to SE pais ine oy wl aap Lege Me jromnest by Hoangh: ates byeomen Thal tunnel 8 Th temo A mand Aye Wee am flaw he, Shestowen 2 pene 4 tatheaplon sl Pon" ree ea ee Cooma wan a, inn ed ene + Te at be Are ines heen 8 ues mel te hayepregvend He pvbltoms + hey yre hh weer) wp Voectelo thes cmd Sah MP Tos wi 6 # ey manent Qeoee © oh ‘t Clinical Exot", ‘DriLeyla, Westmead (Case: Cranial nerve examination $8 head injury in the ociptat reron. Task Examine I-VT. erent nerves only. “Materials necessary fr the exam Were supplieé onthe table. {get thep, took persica fc exanintion Inthe begining we ted to examine the back ofhead examiner wasnt happy he asked abot ese Las die wh di ot ex the back of bea, eat ey le necessary or assesment fs wana p they led 0 ey be depends on examine) How ever onthe ble thar war pia (Rede cena vision etiperl vision d for pia eck ease}, coton tal reg fk Peed hve any poblein 38 iedings were aormal, * Whea I mentioned about Hid from the ene seeminer asked ms toda Oloseopy (CASE 2: BEE STING- PEDIATRICS foe, “A « 6, ae 9.73 old boy ho Bee sting injury in the apper ip, mun bas cem-ve ssvollea facelip. You ae lathe GP. ‘Taake Manage the pt. Talk abou ute preventicn, Answer tbe examiner's sion, todo owas Tl tema det ht yr hil i singin Lad ay Saly 2004 5ydnew ion white fer arg He ea ee nove C10 side, /-Ubave area calle Uz ambalace it on To i details after mangling the enbexgeory pxcblem. Tae “Bhat atop pen pce et fons shee ndvcia — 0-8 +25 fn any nee Boeheenevetoot Ve ne ee es rd Howe smerny Fines clots ate bring Mout % coy, 1 When ded gene Shoot notre, 2 fe Here my prin gee dummy 2 Tae gen wobeuk any quakes 9 flsid Ym amyinn? Prdgmnees Or gee EE ong Uae ee o at you pebler-Tecterhas prin in Becht hatd premenilrat eutin — f oes ay for a0 2 premenslonl ewe yen ome Ig. ork bhectewnal 7 CASE 4 CARPAL TUNNEL SYNDROME. PLE 134 GP 684 x, exam de Manag, gost le cnet 0K? pete) om © Brek gam Howe Ane coe reyes leroy 2 Bphacesen ges yan delve har Gin. biooek sud? Moor dad yor Sf Tp ya Sak De yee bnew’ agers Lloegr py), eek Ee Bo ges Kt gern Bh decks 2 ox fom the bed & gave ito the P) spo geen Rowe tg. Bthew wastoons Anan 9 bye D0) Wie erly a ost. seca D : ian ; lect endemess in LB. wer SN ee er eel 2 One 4 Ritts we XE a ag ef er par! =. rab Addevoraal keyg yon a oe ppbv 4 Speci 2 byte Whar dy yer pve We : i here do gow Be WM Jer re tespihenk 2 a4 Te ake yew 1E pryymemny 2 ae pra yor doing ory grace bees oF vey reenahe am de gee : | kes 3 “ ‘noone | seen eroming Getty plier Ge on HN [ene ae UM be gente we men 0 9 Chee Gate fk omy a se Then’ ' exiyteegytnde gat Mat ae Joh tab me bene? curerciy tery dale yore 4 te ofthe et fa een ae we 9 gary meee Feet demgh werbee Nt gate ONE me 2 9 F Leaner ent hive me Ge v C ghoect dt abe pater, = beep pe ™ jee boy. heene! eae : oR soak BE pe wen ELE tion no need We scare Answer ¢xa Bate fr jak whet } we wy MR boa ( jens) we gen bean ( ia. te Posh snndet depressrrnn feel thal can fuse wort Waste you haa dr grok Mave gen blew Jarliny wervy ay “dees > . feck Tribe ble “or angey ett your boty? Kabra ship writ yomne esa ) A a CO os ge Yodan aiek 2 eaath wmanaize game beng omat ste, Layla) SDs yen ow eye YF pe Do rgeon baw ; or yo helo oe plan reg Fieteinew elect pa valek egrenon CATS CLAMEHEMACTINE aah cunstrhias coheed POT Lat 23y yes medical student fall nrg sto whak ye 9 fe, semenn offer he gent & ‘ven aerial Expat he pt ite ngs, sa Gath Aflorntodeciog mpl asked about pin do oa Bh cen hepp ia mn wp & pad fe Toe no Tam fine thanks Cor acking. Asked forthe X-ray (ean gaffe cht ele agj6 i: te herman 4 foe hs event | Afkee delivery nak : f dat che peepegres BITE each ” ghaker pod meg eB guar wilt kecgeonlt sepport may) Pr GI bere, Sevres shik tt 41 cack TH © Yan cont sae sank Hath ome eee ee ,y we ee pene Jon wi tr need wily oe tes students 0 atendiog cases wi plaster ling bayer" you? " jew yew nournl, ssppactherhe Skmesis. mromate a Syethnye ‘ Jor! haf ttc SR de Bol yom feu oy digginers Pore ae Bet gem fe t ” ene oh spowops) peak suveatny? & o seb wah, Youtbag sue um premand sill, died reg Seoms hue AU wm Tone) eplprg.t 1 jek = we by mttaer 9 Poy peyerologreh feck tp 2 BAL gin hme cmon sup Oh 22 ey ? et? Thm emetmet pecd . os rot sharing y shaking ve Stemset behav foe eck omy Senstin pe ta callow? (vargas ) ‘ ° Lanal tng cfee? dae ge tat vepicie Me reme ) enen vorearbning offi’ shrew call hehe Stenosis. BS ge Ba. Que Bh pw + mpply ta & S Hh tom game pening 9 Hine / gorse ope") dha openisy ee Me - then Tha ope Js ny sapiesen tly deer eee La caer ewsugh bleed | fave to 4 a eh offerte’ 89 test Vs te ed Lo onaden eqerer eres) Sa bret, ote ge gengenh a temas 4 wnile jrakes tu yk teva. mere ae ge NET. renee bine vNt de @ he chee ol (Care 10-DABY NOT MOVING WELL, €X0% +25 1 ‘exam, Invand Mie ‘Usually baby moyes 20dmes /day Fr the ast $kours baby moved abou 10-12ies, Wee Tf ny | ced to cont that baby efi. for ebservationd Ul we get the CTO ond check te aby. ng of CTC says anion very al spa ay emer edict nity bt nou cae saiay on Yt Petey Cato L-POSTNATAL DEPRESSION Pr5. 10 ,&P. 105% ‘2ays back baby was delivered now mum slo weakness, now she has two babies ane fs 30, ‘monte another ono it 20 cays old. Hushand- self employed broker. ‘ask Hx, Exam, OD, lav, Ms Hx- Q Toll me more abst your problem? Pr-Always felstcedvants 10 Zl bappy but fas, ° Groin Meester”“1g tholang rus. e@ £#Q.2ccaminer asked about Provisional Dy/DD: evn Dts Aa ea . Cereat gene De eS, Seulmebive. ennbioyepntig + wt, Fimetoemilees Whamidare eects goph dale stbhsnnd Eon Trt tredinine OL". Ex-Q what luvestigationsd6you want tod Base line bld- CBC, RFT.LET.S, seth spect Coda (Case HITV COUNSELLING: Pig ,2 Se pe 2 ‘syacldnis ne obugak nsx rit posites doreae'a Task Pete HIV coueslng, ge 1, ECG, CXR. Urine,» / Me aay think shout doing av Ee an Heinle] “QdModeofsex? Pe-vasina, ce a Gomucedaar Pent pocces AS, > a? Gis on prostates eter Brith cay see see ON cob elves, QPrevious W/O STI? Pt-No casey” (Q BG patent Am fain Ele . age earhak, yon con Fete IM @ adwie abowd Narfarin / IN ¥ nant abet FE prthttene itor tagniiy HF neede & be sch eclel by —— ne Ae (GP)Fee ee ee ee tens an nee poemne AUSTRALIA MEDICAL COUNCIL Freese Hedi AUSTRALIAN MEDICAL. COUNCIL ‘bi! | [STRUCTURED CLINICAL ASSESSIMENT STATIONS cwniea ye STRUCTURED GLIIICAL ASSESSMENT STATIONS SYDNER AUGUST 2008 SHDNEN AUCUS? 2006 » estrus 5, STATIONS. os stanton? 25 Yew od a the emerge depres fom severe tad sing oP sails = bout the pai. or patent about thejuse of Pethedine, $Mtel your patent your management plan, h che Hos om ecu PY O ASE eon pain Qu Ss - : a Sonnhen ndsate|p neta mAs o- IL aye @ ra patent AM ppb wih Po ctrchies” - . ‘ adarctun, dapunsfg , AE wramd | bynes pt gnptemr . a4, 6 pk alot gratin, tmokaiy , TN PHY, Sn exeme ode we rxplere SoM gob lum: ve bn @ riain Hiry trad you iasick Not ght Year mw: wet patra He wating git anot— ae th Erlb sha] insists M wphang e pe or nanden a bo ad te OY atcahel clrare Oren pa prethay me prrgenmn ardo figuras ) mw .AUSTRALIAN MEDICAL COUNCIL, STRUCTURED CLINICAL ASSESSMENT STATIONS: SYDNEV\ AUGUST -2008 STATION 12 24 year old male presented with bleeding, per rectum, Your task isto 1\Take further relevant history. . 2\Ask the examiner about the physical fodings you want 3\Explain your management plan, ojeed PR AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT STATIONS: ‘SYDNEN AUGUST -2008 STATION 13 Nathan, a 9 year ald child broug rea tan ‘recently. His teacher has notic tells bis mum that be feels detached from thes performance in the school has delayed recently task is: ‘WTell the grandmother your diggnosis; 2\ Counsel her on your managetseat plan. AUSTRALIAN MEDICAL COUNCIL STRUCTURED CLINICAL ASSESSMENT STATIONS -* SYDNEY AUGUST -2004 . STATION 15 18 Month old child brought in ty his mother bepause she was worsied that her ehild can't move his arm. You did an X-ray which showed} receaf spi} fracture and 2 old fractures. On your physital tion, yor fdund traces of bid finger pried overs arms and bruises over his tammy. Your tasks jo: Jel te mother you suspic agnosis& a Mow Ir. AMC CLINICAL EXAM ADELAIDE 11 SEPTEMBER 2004 A case of COPD. Explain to the patient the results of the spirometry and the diagnosis. Instruct in the use of the inhaler. ahve teen OCP-induced hypertension. Three consecutive readings of high blood pressure in a 26 year old woman. Take 2 focused history and explain your diegnosis. Discuss the other ions with the examiner. @@#pa- Heer rete 1% exer ne) z en 6 F oP ( plgwsten +f cpap h i wathmess we h Y Kh 2 A-46 year man with a history of high alcohol consumption. Second visit to discuss the results, ey of the previous test (GGT high and MCV high, the rest normal). Patient is concerned about _ 7 we ~ alcohol intake, Advise and counsel. _ A case of hypothyroidism. Middle-aged woman complains of weight gain, fatigue and lethargy for a few months. Take a history and propose a diagnosis and a differential diagnosis. A caie of strabismus in a twelve month old boy. Explain and manage. ¥ A6. A five month old child presents screaming ana pL ‘A lump is felt at the right side of the @ umbilicus. Explain to the mother the condition and the management. Intussusception. 7. Aseven year old girl presents with a sore throat and a runny nose. Ask the examiner for the % examination findings and discuss the management. Possible viral infection. >? =~ 8. AAA. Amiddle aged man comes to discuss the results of an ultrasound which shows an * aortic aneurysm with a 7em diameter. Expiain the condition and discuss the management. “AA 26 year old woman presents with acute RIF pain. She is trying to fall pregnant. Ask the examiner for te examination findings and investigations. Possible case of ectopic pregnancy. Postnatal psychosis. Take the history from the woman's partner and explain the condition to him. Third week after birth. A woman in her 37th week of pregnancy comes to discuss the results of a vaginal swab whic. ! is GBS positive. Explain, advise and management. 12. Examination the hands. Case of rheumatoid arthritis. 13. A middle aged woman presetits with fever in the first 24 hours after undergoing leparoscopic «rf cholecystectomy. Differential diagnosis. vi dnyve, 14. A young man is referred by a neurologist after his second episode of convulsions. Explain the condition, advise ahout driving and the side-effects of the medication, por F815. A 54 year old woman presents with shoulder pain radiating to the neck and the thumb 2nd index Guger. Take the history aud discuss nsanagenent.typuier Phage dures, 4 2 16, °“A'26 year old woman of OCP presenis with two month of ainenofshoes. Take ile history. : ask the examiner for the examination findings end discuss the condition. The exe ings were normal and investigation results were not given. Bde fms feat Sher ae tet10. aL 12, 13. 4 1s. . 35yes lady 2 yrs hx of headache. (tension head ok Sl Mow 62P138 wks AOG I" bora 4kg, enevenifl labgur. Now cervie dem found breech presentation. Mx. 16:5, Gel in ED. Mam bought in and concernes about weightloss. Con the gil and Mx. 6yrs boy hx of URTI, Nose bleeding, Cov. and 28 wks AOG GSP4 Hb 8.0 micrecytosis and hys 30+ man came for wst results. BP 140/84 hyper yrs found murmur when treated AOM, Return ED. 20+ sudden SOB while walking. X-ray 20 ‘Schizophrenia on Haloperidot 3years. Concemet affecting social life, Request weatment from yor 30+ landscaping worker. Lower back pain after quest exam and inv. results and Mx. Jhromic. Con. and Mx pidacmia. Give results and Con. Ly for review, The murmur is soft at con. Mix. puevmothord. Mk ‘shout other people noticing mouth movement, £0 that because his psyichiatrist on leave. eavy lifting. Mx. 60+ male bright blood at end of urine. Hx of kidhey stone 20 yrs ago. Mx. 10 mths, undescent rhost ass.with hernia. Mx. 21 yrs lady concerned about hiair-grow on face. Chronic disease with haematrinesis, Gl exam. 30+ breast lump, FNB malignant change. Give results and Mx. .. 20+ lady DVT after air wavelling in ED. Mx <) recent 2-3 months seems worse. Mxa HALT A 2A ITAL @ — 1 ly Mow AMC Clinical Examination Recall Brisbane 16" October 2004 At the end of each question in capital letters is the topic as it was recorded on the assessment sheet from the AMC. |. You are a Doctor in an Emergency Department of a metropolitan hospital. A young man comes in after an accident & s having difficulty breathing. He is conscious & co-operative. Tasks: Examine the patient, (4 mins). Ask the examiner for the X ray. Describe the X ray. Manage the patient. No more history to be asked (INJURY TO CHEST) 2. 45 year man comes with 3 week history of increased thirst, loss of weight & increased frequency of passing urine. BMI 34. Non smoker. 1-2 drinks per night with food. Do the necessary office tests. Ask for the results ffom the examiner. Explain the diagnosis & implication to the patient. Manage the patient. (DIABETES TYPE 2) 3. A32 year man, some problem in throat, Toke history. Examination findings from examiner ( will tell you only what you ast). Order investigations if necessary. Explain diagnosis to patient. (LUMP IN THROAT) 4. Father of 3 week old child comes to you as child is vomiting profusely since last 2 days. No diarrhoea. Father says “ vomit went everywhere” Baby is on breast milk, feeds well. On examination. Baby looks well. Hydration good. Vital signs given. (All normal). Giant peristaltic waves seen on the abdomen. No mass felt. Tasks: Explain to father what the problem is. No further history to be taken. (PYLORIC STENOSIS) 5. GP practice. Young woman comes to you with lump in right breast that she felt few days ago on self examination, She comes 3 days after menstruation. She is on the pill (microgynon 30) Past & family history negative, O/B you find a single nodular lump on the right breast. Tasl Explain the diagnosis to the patient. ‘Tell her about immediate plan for her. Allay her concems about breast cancer. (BREAST LUMP) reel. Mobile, non tender,ie LILA 25 year female comes to you at am after she had been toa party last night. There she ‘met a person she knew who offered her a lift home. On the way home he went off onto a dirt track & raped the gitl. She now comes to you in ED & does not want to involve the police, Tasks: : Any firther history. Ask Examiner for examination findings (you will be told only what you ask for). ‘Manage the patient accordingly. (POST RAPE CARE) 12. A45 year female comes with recent H/O of loss of weight . Tasks ‘Take detailed history, Ask Examiner for examination findings (you will be told only what you ask for). Order the necessary investigations. (WEIGHT Loss) 13. A 5 year old child who is seeing you for the first time as they have just moved into the area. The previous GP they saw said that the she had a heart murmur, but asked them to only have regular checkups. Child is active, healthy & growing well. Has to zo to the dentist next week. O/B: Murmur. Intensity 4/6. Radiates all over the precordium. Tasks: Explain the diagnosis to mother. Answer her questions. (vsD) 14, Male 26years old comes to you as father , 2 plumber died suddenly at 57. Was in ‘perfect health’ before that . Never saw a doctor. Mother is a regular patient of yours You see her for Pap smears & mammograms. Talk to the patient & you will know why he is here & then manage accordingly. (SUDDEN DEATH) 15430 year old female comes to you requesting home delivery. Is 12 weeks pregnant now. ‘(HOME DELIVERY) 16. Young female patient saw you last week with symptoms, You did all the tests & everything has been ruled out (ufler ECG......) You come to the diagnosis that it is gehecalized anxicty disorder. Pat happily married. Is in a senior position in a company, has a lot of worries, says has too many projects. Smokes 15 cigarettes a day, 4-6 cups of coffee a day. Drinks socially. ‘Tesks: Exp the diagnosis to the patient. Manage the patient appropriately. No further history to be taken. (GENERALISED ANXIETY DISORDER)