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Recall Brisbane May 2010

Recall Brisbane May 2010

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Brisbane 8th May 2010

(The comments in the boxes belong to another candidate)

Paediatrics
Q.1\ AMC book -condition 20Questions asked by the role player: 1. What is DM? My father has DM, is it the same one? Me: No, the one your father has is called Type 2 and it is different from the one ur son has which is called type 1 DM .Type 1 DM occurs at younger age in which there is less insulin production from the pancreas which is responsible for regulation of the blood sugar in our body. This occurs due to destruction of the pancreas possibly due to autoimmune condition (our immune system attacks our own cells). 2. Will he need insulin for the rest of his life? Yes 3. Who will give him the injections? 4.How?Here I think I misunderstood the role player coz I thought she asked me to explain the method of giving an injection so I wasted a precious time to explain that. I believe we just need to tell her about the site of injections, the number of times a day......... 5. What about increasing or reducing the dose? Who will decide that? Me: The specialist will decide that which will be based on several readings of the blood sugar....I explained about the glucometer and monitoring of the blood sugar. 6. What should I do in case of hypoglycaemia? 7. What should I do in case of hyperglycaemia? 8. What about sport? In this case I always reassured the mother coz she was so anxious..... However I could not finish my task on time so when the bell rang I told the examiner while going out that I need also to talk about school and camping. AMC feedback- Diabetes type 1 juvenile-counselling (Paediatrics) -PASSED

This case is exactly same as the AMC book... but the mother was worried and needed reassurance and was asking about the cause of DM......Passed

Q.2\ A father brought his seven year old daughter who is complaining of recurrent headaches. Task: Hx, ask the examiner for the examination findings and management? (My D.DX included the following: Tension headache, Migraine, Meningitis, Haematoma after a fall, Brain tumour ,Others like Infection such as viral or chest infection ,Visual problem ,Sinusitis and hypoglycaemia ) History - I do understand that u r here today coz of ur daughter? Could u please tell me more about it? (He did not volunteer useful information so I start to ask questions) -How long? 4 months -Where? Like a band around her head. -Does she skip school coz of it? No -Does it affecting her daily activities? (I cannot remember what he answered) -does she complain from this every day? No -Is it there all the day? It starts in the morning and (I think he said until the evening) -What about the weekends and holidays? No -What relieves the headaches? May be Panadol -Is this the first time? Yes -Is it getting worse? Yes Then I started to ask questions to exclude my D.DX -Any family history of migraine? My sister has migraine -any family history of brain tumour? No -Does she vomit? Any nausea? Does the light hurt her eyes? No -Any fever? Wt loss? No -what about lying or bending? Do they relieve or worsen the headaches? No -Any weakness in her legs or arms? No -Any history of recent fall or head injury? No -Any recent infection? Sinusitis? No

. medication and allergy..-Does she skip breakfast? No -Is she enjoying her school? No. nutrition and development)... well or unwell? Looks well -growth chart? Normal -Vital signs? (I cannot remember the exact numbers but they were all normal) -Rash? No -Fundoscopy? Normal -ENT? Visual acuity? Sinuses? Normal -Neck stiffness? LAP? No -Chest and heart? Abdomen? Normal -Neurological examination? Normal .All were normal Also asked about general health. -does she love her teacher? Yes -What about her school performance? (I cannot remember what he answered) -Can I ask some personal questions? Yes -What about the situation at home? Very good -r u happily married? Yes -Any interpersonal problems between u and ur wife? No -R u both having enough time with her? Yes -Any financial problems? No -Any other siblings at home? Yes (I cannot remember the age) -How is the relationship between them? Very good Then I finished my history taking with the usual BIND questions (birth and pregnancy. I tried to talk to her teacher about that several times but we could not do anything about it. coz there r many students there who r bullying her and make fun of her and she is very upset about that. immunization.All normal Examination -General appearance.

I told him “I am very happy with my examination and it is very unlikely to be something serious but if u like I can refer u to a paediatrician for a second opinion” AMC feedback – Headache-tension (Paediatrics) -PASSED I referred the child to psychologist. school involvement. Other management Social worker.. from what u have told me and from the examination. he said.He has diarrhoea about 5 or 6 times and vomiting about 4 times (I cannot remember the exact no.3\ A six month old baby brought by his mother .. could it be brain tumour..Passed Q.). Review.Management Mr x. ur daughter has Tension headaches due to the stress that she has at school. ask the examiner about the examination findings and management? History -I do understand that u r here today coz of ur son? Could u please tell me more about it? (Again she did not volunteer useful information so I started to ask questions) .. family meeting and ongoing support from me. but the role-player asked “Is that necessary? And what the psychologist will do? So I explained that the psychologist is expert to deal with similar situations and he will help your daughter to identify the stress in her life and teach her how to deal with it. Task: Hx. He laughed and said I know :)!!! The role player here was so anxious after telling him the diagnosis so asked him if he has any concern.. The headache is real and genuine. Our body and mind r connected together and when our mind is upset.. It is not serious and we have a lot to do about it.. Also it will be a good idea if u can take her for a holiday.Always at the end of each case the 4 R: Refer.... Red Flags and Reading materials. I forgot to refer her to paediatric psychologist as the bell rang when I was talking about the management but I told the examiner when I was going out that I have more to talk. our body can respond in different way and in ur daughter’s condition it is the headaches. First of all I need to talk to ur daughter and also we need to arrange family meeting. Also we will arrange social worker to go to school to talk with the teacher coz the most important think to treat these headaches is to remove the stress.

...She accepted my advice and she was very willing to have her baby immunised. Then I asked about BIND. how will u rate his feeding? Probably 80% to 90% -what about wet nappies? A little bit less -From 0 to 100%? Also 80% to 90% -Any rash? No (to exclude meningitis) -Is he crying a lot or looks irritable? A little bit -Does he draw his legs or look pale when he cries? No (to exclude intussusception) -Does he cry when he passes water? No (to exclude UTI) -Have u travelled recently? No -Does he go to child care? No -Any contact with similar condition? His brother (4 years old) has similar episode 4 weeks ago ...-How long? 24 hours -Is the diarrhoea watery or semi-formed? Watery -What colour? (I cannot remember) -Any blood? No -Is it explosive? No -Is this the first time? Yes -What about the vomiting? Colour? Milky -Is it projectile? No -Any blood? No -Any fever? He is a little bit hot -Is he feeding well? I breast feed him and it is a little bit less than before -From 0 to 100%.Now he is well.. Beside it contains vaccine against rota virus which is the main cause of diarrhoea in children.The mother said that he has not had the 4 month shot for some reason (I cannot remember why) so I told her it is important to immunise him coz it will strengthen his immune system and help him to fight against diseases.

Examination -General appearance? Normal -Growth chart? Normal -Signs of dehydration (fontanelles. skin turgor and CRT)? All normal -Vitals? I cannot remember the exact no.. . (Here the mother asked if she can manage that at home)I told her “Yes u can but I would like to see him in 6 hours time to re-examine him coz babies at this age can easily get dehydrated.. But they were all normal except the temp.. During this period if u noticed that he is unwell. ur son has gastroenteritis most likely due to viral infection.then by palpation for masses and pain? Normal Bowel sounds? Normal -Inguinal orifices? Normal -Urine dipstick? Normal -excoriation of buttock? No Management Mrs x.It will resolve by itself within 3 to 4 days. Was 37. There is no specific treatment or antibiotics coz it is viral infection.. does not feed well or less wet nappies or u r worried for any other reason. bring him ASAP to me or to the ED.. The most important thing is to prevent dehydration.. Also coz this type of diarrhoea is contagious so try to keep him away from his brother and make sure u wash ur hands after changing the nappies or before handling food. I also gave some written materials. dry mouth. So I would like to refer him to the hospital for observation for few hours and oral rehydration solution until the vomiting settles down. So continue breast feeding but frequently and in smaller amount ...7 -Any rash? No -ENT? Normal -Neck stiffness? LAP? No -Chest. heart ?Normal -Abdomen? Starting by inspection? Normal.. sunken eyes. from what u have told me and from the examination.Also give him ORS a mouthful amount every 15 mins.

Her next antenatal visit is in 2 months time so she has been told to visit her GP for initial Investigations.. FBE &Hb.Also it is important to start taking folic acid for the first 12 weeks of pregnancy. 4.. Q.. I do understand that this is ur first pregnancy? (Yes).. hepatitis also we need to take some cervical swabs for Chlamydia and gonococcus infection.. Also if u like we have screening test for Down’s syndrome that we offer for any pregnant woman although u r still young. I told her that she can but she needs to keep her baby away from them.. This is her first pregnancy. she has a positive pregnancy test at home after nine weeks of amenorrhea . 2..encourage breast feeding and immunisation.Then the mother asked me if she can visit her cousin who has 3 children. Task: Counsel her about the initial Ix she needs until that time and answer her questions. Her pap smear was done 6 months ago and it was normal. BG & indirect Coomb’s test....have u started taking folic acid? (No). I talked about the following: Congratulations for ur pregnancy.Her periods are irregular.... or I can refer her to hospital where her child will be assessed and then discharged when he is feeling better. I said”iron but first we need to check ur Hb level” (I am not sure if this was what she wanted to hear) .. After ur permission.. VDRL for syphilis.. 3. Passed Obs & Gynae. AMC feedback –Gastroenteritis (Paediatrics) -PASSED I gave the mother options either taking care of the child at home (if she can) and I need to review him in 6 hours.4\ A 28 year old woman comes to ur GP..So first of all we need to confirm the pregnancy here in our office . Rubella and varicella immunity status. screening tests against certain STDs including HIV. Midstream urine C&S for UTI... We need to do routine initial antenatal tests which include the following: 1.4R. We will also do U/S to confirm the date of pregnancy coz ur periods were irregular (I am not sure if I should have said that or not but I had a plenty of time so!!!!) The role player asked me if there is any other medication she should take.

gynaecomastia)? Normal -Chest and heart? Normal -Abdomen? Normal -Inguinal orifices? Normal -Genitalia (Inspection: pubic hair.. spermatic cord. I advised the patient as in the book but I also told him “u have a swelling in the scrotum most likely it is called varicocele which is dilated veins like varicose veins in .. and disappear when lying down.. scrotum.5\ AMC book condition -64The differences were the following: 1. size of testis.. any swelling. if u r immune it is safe but if it is not it is important to stay away from children especially the first 3 months coz it is the critical period for the development of baby”. I believe the critical errors in this case r most probably to offer down’s screening . Failed Q. I mentioned... (Here I should have asked also about transillumination and may be others but I was in a hurry as I wanted to finish my task) -Urine dipstick and BSL? Normal 3..... OR very less likely to arrange U\S to confirm the date of pregnancy since her periods r irregular OR to arrange varicella Ab screening coz I know a candidate who failed this station and he did exactly like me apart from the above 3 things. early U/S or Varicella Ab screening. AMC feedback – Investigations during pregnancy (O&G) -PASSED I offered all the antenatal care Ix mentioned above.. In the examination I asked the following: -General appearance? Normal -BMI? Normal -Secondary sexual characteristics (axillary hair.. beard.. (So I asked the examiner about the CCC of the swelling?)It is not tender. feels like bag of worms.. can get above it... any swelling)? Both testis r present and of normal size but there is a small swelling in the right side.Also she asked me if she should continue her job as she is a teacher? I said “It is up to u but let us first check ur immunity status against Rubella and chicken pox.. but I did not offer Down’s screening. Task includes examination 2..Palpation: can I feel both testes. as you are a childcare teacher it’s important to avoid contact with ill children or children with fever.

History -I do understand that u have been complaining of a lump from the down below? Could u please tell me more about it? I have this lump on and off for months now but it is getting worse now. -Can I ask why u had ur womb removed? Coz of heavy bleeding. -Any complication after the operation? No.Passed Q. He accepted my advice without any comment and then I completed my task according to the book.PASSED I just did as the above candidate and as the AMC book. it makes me feel uncomfortable.please -r u sexually active? Yes. comes to ur GP complaining of a lump going down on and off mainly with sneezing and straining.. AMC feedback – Primary infertility (O&G) -.. -Any problem with passing water? No. So I continued my history taking.. everything was normal until months ago when I had this lump.the legs . -Is it there only when straining? Yes -does it disappear by itself? Yes Here the role player said “I had my womb removed 13 years ago”. I am married -does this lump affecting ur sexual activity? Yes. Task: Hx.. Actually she surprised me when she said that coz I was almost sure it is uterine prolapse. -Any bleeding? Discharge? No -Can I ask some personal questions?Yes.6\A woman in her 50s (I cannot remember the exact age). ask examiner for examination findings and management.. completely fine. -Any bleeding after sex? No -Have u had any HRT before? No -What about ur pap and mammogram? Done regularly and normal -How is ur health in general? Fine .It can be related to ur problem but do not worry coz it is a treatable condition so I will refer u to a surgeon for that”..

. -Do u smoke? No -Alcohol? Socially -Some people used recreational drugs. .. the vagina comes down... it seems that u have vaginal wall prolapse (Actually the right thing to say is “Vaginal vault prolapse” and I knew that but it just did not come out so I just said wall prolapse. tenderness? No -Vaginal examination after patient’s permission.. -then by speculum examination... have u ever used them? No -Any chronic illnesses? No -Any medication? Allergies? No Examination -General appearance? Normal -BMI? 28 -Vitals? Normal -Chest and heart? Normal -Abdomen? Starting by inspection? Normal. starting by inspection. any masses.. -Then I would like to use Sim’s speculum in left lateral position and ask the patient to strain again to look for cystocele or rectocele? Normal -Urine dipstick and BSL? Normal Management Mrs x.. any lump? No..Palpation.also I drew to the patient and explain the condition but please read more about it as I have no enough information and I am not sure if what I said is correct or not). any lump? Yes.Do u have children? Yes 2(or three) -What about the deliveries? All NVD and without any difficulties.. from what u have told me and after examining u. any discharge? No -Then I would like to ask the pt to strain.-any wt loss or loss of appetite? No -do u have any cough? Constipation? No .

2 months old and 30 months old. presented to u one week ago with a history of tiredness ...Today she comes to ur GP for the result.so what treatment do u prefer?(The pt. feeling tired (I cannot remember the exact words) -what about ur sleep? Cannot sleep.wt loss and inability to sleep..this is not serious but with time it can get worse and might lead to ulceration. feel anxious -What about ur sexual desire? Reduced -Do u go out with friends? No... says she wants to find a final solution to the problem so I said:)so we need to refer u to a gynaecologist who will do further assessment and most likely will decide an operation. TFT and (many others that I cannot remember) all were normal. no problems at all.7/ A very long stem of a women has 2 children. Task: Take focused hx. We have conservative treatment and surgical. counsel the pt about the treatment in details? This is a very weird station as when I was outside I thought it is definitely severe postnatal depression that needs urgent admission. we have received the results back and I am pleased to tell u that all of them r normal. U arranged Ix for her one week ago including FBE. and no signs of depression at all so I said to myself may be she is not a good actress!!!!) -How was the pregnancy and labour? All fine.Coz u had ur womb removed.. this can leave the vagina unsupported and with age the ligaments become weak. -How is ur mood? Not good.. History -Hi Mrs x.. walking for 30 mins every day.She thinks life is not worth living but she does not have infanticide idea.actually I did not have time as the bell rang!!) AMC feedback –Vault prolapse after hysterectomy (O&G) -PASSED Psychiatry Q.. do not have time -Do u have enough support? My husband is very supportive . healthy diet( I am not sure if we need to talk about pelvic floor exercise .. She is always worried about her baby as he might die from SIDS . but life style modification is also important and u need to lose wt.. So can I ask u few questions to clarify the problem? Yes(here I was surprised that the role player actually was a happy young female.beside I was wondering what else I should ask this patient as the stem is too long and I did not have enough time to read it carefully so I can figure out what else they need so I just decided to follow the usual psych hx except things provided in the stem.

. Also the psychiatrist most likely will start u on antidepressants medication.. what will u do? Run away -Do u think u need a medical help? Yes -Do u have any past hx of any illnesses or psychiatric illness? No -Any family hx of psych illnesses? No Management Mrs X......... What u have is a condition called”postnatal depression”.Here the role player interrupted me ... share ur experience and have good advice...She smiled and said ”That was before but now I do understand that I have responsibilities and I should take care of my children”!!!! -Do u smoke? Do u drink alcohol? Drugs? No -Do u see or hear things that other people cannot? Do u think someone is trying to follow u or spying on u? Do u think TV is talking about u ?Do u think that u have special powers? No -If u r in a cinema and there is a fire.. It will help to identify the stress and deal with it.... she just needs some help so I said.. we have good support group that u can talk to them. The role player asked”what about breast feeding”. What I’d like to do is to do admit u to the hospital for further assessment. Also I’d like to arrange family meeting .Here the role player really surprised me so I said “But I do understand from ur notices that u do not think life is worth living!”. So please do not worry..There r medications that r suitable for breast feeding.-What about ur family? They r interstate -Do u work? No -Were u working before or do u want to start a job? No -Any financial problems? No -Do u think life is worth living? Yes!!!!!...(Here the role player said that she does not want to be admitted to the hospital and me personally I did not find any reason for admission as she was smiling ..It can happen to women after deliveries and it is treatable. however the best will be decided by the specialist”.Then I said: Also we need to arrange a social worker and also liaise with the local community nurse for any help u need.. I said”This depend on the type and dose of medication ..no suicidal ideas. I will refer u to psychiatrist ASAP for further assessment and for CBT which is a type of talking therapy based on weekly sessions..) OK then..Also beside my support and regular follow up.

.She is a very busy solicitor. I reassured that her condition is common and has good outcome with treatment.Passed Q.r they 100% sure? No.. but I decided to go with what I know (post-natal depression)... The early features of this disease are disturbance of thinking and short term memory.. By that I mean exclusion of other correctable causes.. what about my husband. She is very concerned about her father and she has many questions to ask. It also causes personality changes.8\ A thirty something woman comes to ur GP asking about her father who has recently diagnosed with Alzheimer’s disease . but she agreed when I explained to her that it is important and necessary to admit her and to be assessed by a psychiatrist.. Dis. support group and social worker.. The daughter has her father’s permission to ask about his condition.and said” Yes... basically Alzh. which in turn can affect the brain function.. I also asked to talk to the husband and check both of her children. The role player asked the following questions: 1.. The person might also neglect himself and this lead to malnutrition and increase risk of accidents at home or outside. the person might even forget the names of his family. When they dxed him with this dis. Task\ Answer her questions..? Me\It is a type of dementia where there is wasting of the brain cells. I am really worried about him coz he is very concerned about me”. (I think also that a CT scan was done to the patient and showed atrophic changes)...It can lead to severe memory disturbance. It is true that we can see some changes on the CT scan.I answered “I will talk to him but please do not worry about that coz they r there to support us and they r happy to do that” . 3.. What is Alzh. however the only definite dx is after death of the affected person and examining the tissue of the brain under the microscope... This will worsen slowly and gradually with time ..I think I should have said something better than that but that what came to my mind at that moment. Dementia is a dis of exclusion. Can it be depression coz my mother passed away 6 months (or one year) ago? ..... 2. The role-player did not seem depressed to me and she was somewhere between depression and anxiety.Then the bell rang!!!!!!!!!!!!!! AMC feedback – Major depressive episode-post partum phase... I admitted the patient who refused in the beginning..-PASSED In the stem they mentioned that a depression Questionnaire was done to that patient and it showed that she was depressed.

he might need a big clock. And at any time if u change ur mind.he will be assessed by a psychiatrist and I will follow him up regularly. social worker. So the geriatrist might prescribe some medication for him that will delay the progress but will not treat the illness as this disease is unfortunately progressive and it is not treatable. and physiotherapist. The social worker will arrange some people to help him in washing clothes in case he needs and meals on wheels and many other services as well. this team is composed of a geriatrist. rails to prevent falling.. occupational therapist. Is it better to put him in a nursing home coz I am very busy and I cannot take care of him? Well.. the ACAT will decide that after further assessment. Also we have good medication for depression in case he needs them.Depression by itself can be presented as dementia and sometimes it is called pseudodementia so it is important to exclude it before diagnosing dementia.He will be assessed regularly by me and the ACAT so we won’t leave him alone.The options that we have r: 1st option. 5. The physiotherapist will assess his ability to walk and might provide him with walking aids. can get depressed especially at early stages of the disease coz they can recognise their disability . for example. u can take him to ur home and take care of him but u will not be alone and there is respite care that will help u to take a break and have some rest. 2nd option is to put him in a nursing home in case he needs that.but please do not worry about that . The occup. Therapist will assess the house and assess his needs. remove any loose carpet and a list of things as a remainder. While I was talking about that the bell rang so I have not had the opportunity to talk about ability to drive (as we need to assess his brain function and if it is well he can . He will be assessed by them to determine his degree of dependency and assess his eligibility for the services that we can offer. psychiatrist. What can be done now? First of all. But Those with Alzh. he needs to be assessed by the aged care assessment team. 4. treat at home if he can cope with that and this is a good option as the environment is familiar to the pt .Well .

.... The task was to examine the patient and write a management plan. the examiner asked me if I understood my task. Also in the question.I believe they were all normal. The pt was a young female lying on bed with a NG tube attached and fluid(as described in the book) 5.(When I went inside the room. The examiner asked to explain to him what I had written so I said “I will give the pt 500 ml of N\S in 30 or 60 min and then review the patient’.. AMC feedback – Dementia of Alzheimer type -PASSED Examination Q... the bladder was assessed by U\S probe and it showed little amount of urine (a number was given).Then I started to look for the signs of dehydration and here the examiner asked me what I am looking for .... dry mouth. 2. I need to start examining the patient without taking any hx?”He said “Well u r the first candidate to do that”!!!!! :) 4.. 3. On the wall outside the room...He answered “Good”.9\ AMC book –condition 102The differences were the following: 1......... Then he asked to give a running commentary while examining the pt so I told the examiner “My examination will include assessment for urine retention... u should do that . otherwise he cannot and his licence should be suspended) and also to give some reading materials.. skin turgor and CRT” and again I forgot to say the vitals!!!However they were already measured by the nurse.. signs of dehydration and signs of over hydration”. and vitals then the rest but I FORGOT.I said (while I was demonstrating that) “sunken eyes..The examiner asked me how I will monitor the pt. I said “The vitals and repeating my examination” but he really did not seem satisfied with my answer and a little bit upset and he said something like the vitals r not that useful to monitor such patients so I said “by putting a catheter” and he was happy with this answer but I told him that I was going to do that if the pt did not pass urine after 30 to 60 min ( As in the book ) but he answered “No.Then I started to examine the pt and straight away I started to examine the abdomen by pressing on the bladder and asking the pt if she has any desire to void for which she said no.. I said “yes... the examiner interrupted me and asked me to write my notes..drive... 6.Then while I was starting to look for signs of over hydration... there is an attached paper includes a chart of the vital signs of the patient since the operation...Actually with any examination it is better to start with the general app.

....... (I cannot remember if there were other risk factors in this case). femoral pulsation and others were intact as well) ..In this station either I did not understand the examiner or he did not understand me!!!!!!!! AMC feedback – Post operative oliguria -. I asked myself “Why do we need to check for urine retention and a catheter is already there?!!!!!!!!!!!!!!!!!!”. femoral.from the beginning” so I agreed and I did not argue with him coz HE IS THE BOSS !!!! 7. adductor hiatus and popliteal) . Then he asked me what if the pt did not pass urine after 60 min. 2.. Task: Perform physical examination (u do not need to examine the vitals or the heart) and outline ur management plan. All the pulses were palpable (No expansile impulse for aorta...Here the pt said that for the abdomen it was for AAA and for the leg it was for a clot removal. come to ur GP complaining of pain during walking which relieves after rest. 1... After finishing that. here my answer was “I will take a sample of urine and send it to the lab to differentiate between pre-renal cause or renal cause “ and I explained what I will measure in the urine. Inspection: There was a midline longitudinal scar on the abdomen and another one on the inner side of the upper right leg. and CRT.And again he was not satisfied with my answer and after trying to repeat the same answer in different ways( coz I really did not know what he wanted me to say) the bell rang and at that moment I said “I will check for urine retention” and here he said “yes that what u need to do” and I went out...10\ A 50 something man... 8.. Then he asked me how much fluid I will give for the rest of the day so I answered as in the book.I asked the examiner if I can ask the pt about them he nodded yes ...However it really took me long time to feel one of the femoral pulses..... the examiner started to rush me and asked what else. 5..He answered “No bruit” .... Temp.. iliac. I think the pt here was a real pt...But after thinking of that after the exam... He asked me to write that as well. I said “Auscultation for bruit and I showed him where quickly (abd aorta...PASSED Q. 4. and he was wearing a gown.......... 3. He is a smoker (heavy) and on ACE inhibitor for HPT.... I started by asking the pt to walk few steps (I think we do not need to do this step so double check that please).

Passed Medicine & Surgery Q.. Also I said “burger’s test and ABI “but he did not asked how to do that and he asked about my provisional diagnosis for which I said PVD Then he shocked me when he smiled and said “the bell rang”.and when I was going to tell the examiner (after asking him about the examination findings) about my D.When I was going to explain the treatment the bloody bell rang again so I quickly said while going out that the treatment is steroid. she wanted to save my time)...DX (I think we need to say neurological cause such as sciatica...DX and the test to confirm that... AMC feedback – Asthma -PASSED . D.12\ AMC book –condition 139 – The only difference is to explain to the pt how to use the peak flow meter . Also I wrote the management plan on a plain paper as there were not any management plan papers when I asked the examiner about it.he said he know how to use the puffer..!!!!!!!!!!! ..DX...DX to the pt.!!!!!!!!! AMC feedback – Aches and pains -PASSED Q....condition 68 The only difference is that we also need to take hx and to give D.This was a very funny station..So I rattled off the D. AMC feedback – Leg cramps on exercise -PASSED I was asked how to perform burger’s test..They both laughed loudly.... life style modification and referral to a vascular surgeon”.11\ AMC book .... spinal canal stenosis and peripheral neuropathy).There were a puffer and a peak flow meter provided on the table . The patient asked me about the dose and type of steroid tablets. he stopped me and asked me to tell the pt about it.6......actually I did not hear it and I said to him that I still need to manage the patient but he smiled and while he was guiding me to the door I said with a loud voice to the pt “u need to quit smoking..... but when I asked her if she wanted me to explain each one to her she said no need( What a nice lady....

However she was answering all my questions directly and nicely).. 1 is the minimum and 10 is the maximum. .13\ A 30 or 40 something old tram driver.Anything worsens the pain? When lying or with deep breathing.( The role player was very kind to volunteer this info.Anything relieves the pain? When leaning forward. dizziness. -Is it there all the time? Yes -Could u describe the pain? (I cannot remember what she answered) -From 1 to 10. fever? No -How is ur health in general? Perfect -Any chronic illnesses such as DM. -have u ever had chest pain before? No -Any SOB. allergies? No .the examiner said to me that I have 3 mins to ask hx so I asked him to stop me after 3 mins coz I will forget and continue asking question . have u ever used them? No -Any medication. Task: Hx for 4 mins. It is getting worse now. When I entered the room . Cough. how would u rate the pain? 6/10 . comes to the ED complaining of chest pain for few hrs.Q. HPT. leg swelling. -How did it start? Suddenly without doing anything but I had flu days ago.I do understand that u r here today coz u have been having pain in ur chest? Could u please tell me more about it? I have been having this pain for few hrs now (I cannot remember how many exactly) and it travels to my back and shoulder. high cholesterol? No -Do u smoke? No -Alcohol? Socially -Some people used recreational drugs.He smiled and said ok History . palpitation. ask the examiner for examination findings and management.

-Any recent travel? No -Is ur chest sore to touch? No Examination -general app...heart sounds? Normal... HB...from what u have told me and from the examination findings.. inflammatory markers. -Cardiac enzymes to exclude MI -CXR to pericardial effusion -ECHO to exclude effusion. Also I would like to admit u to the hospital and u will be assessed by cardiologist ...... .?She is in pain -VS and O2 sat. First of all we need to do ECG to confirm the dx .....Pericarditis by itself is not serious and it is self limiting condition but it can lead to serious complication such as pericardial effusion and temponade which r collection of fluid that may affect the function of the heart....?Normal (I cannot remember the exact numbers)....I asked the examiner if it is a rub? He said YES -Any signs of heart failure? No -Lungs? Normal -Abdo. -any added sounds or murmurs? There is a noise . It can follow a viral infection..The following ix will be done as well: -General blood test such as FBE.. most likely u have a condition called Acute Pericarditis which is inflammation of the covering of the heart.?Normal -Leg swelling? No Any Ix available? No..I think the examiner asked me about my provisional dx and I answered ”My provisional dx is acute pericarditis but I need to exclude MI coz every chest pain is MI until proven otherwise” Management Mrs x ... -heart? any thrill by palpation? No.

-What were u doing before the fall? It happen when I get up for e.. -When was the first one? Few months ago (I think 6 months ago) -How many times? 3 or 4 times -Have u sustained any injuries? Just few bruises... The role player asked the following: -How long do I need to stay in the hospital? Me\Probably few days but it depends on the severity and the progression of the condition..... Please do not worry coz u will be managed in good hands. d. . as depression .Environmental as messy house)...The treatment includes high dose of NSAID such as Ibuprofen every 4 hrs and regular monitoring to detect any complication earlier...I do understand that u r here today coz u have been complaining of recurrent falls? Could u please tell me more about them? (The role player did not volunteer any new info so I started to ask questions).CVS-structural or arrhythmic-. History This was my first case and I put the following d.. in the morning when I get up from the bed. -Could it be heart attack? (The role player was a bit concerned about the chest pain) Me\It is unlikely but we still need to perform some tests to exclude it.... -Did u feel dizzy before u fall? Yes .14\ A 70 years old man present to ur GP clinic complaining of recurrent falls...postural hypotension-medication and DM-......g.hearing and balance.. AMC feedback – Pain in the chest..... ask the examiner for the examination findings...psych.He had stroke four years back with weakness of the right upper and lower limbs..... back & shoulder -PASSED Q. Task\ take a detailed history for 4 mins..alcohol.TIA-.dx and management..musculoskeletal such as joint problems.vision .hypoglycaemia..dx when I was outside the room(Neurological-epilepsy ....

-Any medication? (The role player here who was an old age man gave me a small card with names of drugs written on it.-Did u lose conscious? No -any problem with speech. diuretics and amitriptyline but I cannot remember the names of the antiHPT medication). weakness in the arms or legs (apart from the one u have)? No -Any palpitation. -I am sorry to hear that..I said ok we will check them.. and how do u feel now? Fine. chest pain. hearing? No . have u ever used them? No Examination -General app.?No. do u have depression? Yes since my wife passed away 9 months ago. I am fine -Do u live alone? Yes -can u manage things by ur self? Yes -Any walking aids? No -What about the environment at home? It is a little bit messy. swallowing. -Do u have HPT? Yes for few years -Is it well controlled? I check it every now and then and it is ok -I can see that u r on amitriptyline. -Any other illnesses such as DM... angiotensin 2 receptor antagonists..Some people used recreational drugs. -Any joint problem or pain? No -Do u skip meals? No -How is ur health in general? Any wt loss or loss of app. heart problems? No -Do u smoke? No -Alcohol? socially .. SOB? No -have u been passing water a lot? Or feeling thirsty lately? No -Any problem with vision. And BMI? Normal ..

occupational therapist and installing an alarm in your house because the patient lives alone.... cranial nerves .The examiner said it is all normal ( with a smile that meant do not ask anymore when we said the rest of examination is normal!!!!!!! as Dr. cerebellar signs...15\ A 30 or 20 something lady came to ur GP clinic complaining of constipation and pain the lower left abdomen for few months...Here the bell rang and I did not have the opportunity to say occupational therapist to visit ur home and physiotherapist which I believe is important to mention ..power .I cannot remember what the examiner told me about the gait...The findings was hypertonia and hyperreflexia on the right side but the power reduced.It seems that the most likely cause is postural hypotension which sudden reduction in BP when changing position from lying to standing..hearing . physiotherapist.. -here the examiner told me the rest of the examination is normal and I should talk to my pt.... and of course changing the medication.reflexes .. So I would like to refer u to fall clinic for further tests and..u arranged some tests like ..-Vitals including BP lying and standing?(I cannot remember the exact numbers but the pt had low postural hypotension) -Fundoscopy? Any HPT changes or papilledema? Normal -Carotid? Any thrill or bruit? Normal -Chest and heart? Normal -Neurological examination?(here the examiner asked me what I want to examine exactly so I started with the gait....This was my first station and I realized here that I am very slow and I need to be quicker .Other causes of the recurrent falls could be due to loss of balance coz of the stroke that u had 4 years back or due to depression and loss of concentration...The most likely cause in ur case is the antiHPT medication that u r on (Other candidate said that amitriptyline also causes that) so it is important to change ur medication........sensation and coordination).BSL and musculoskeletal.. AMC feedback – Recurrent falls -PASSED I mentioned referral to fall clinic...upper and lower limb examination including tone .however I could not achieve that in most of my stations but what I could do is to continue talking especially the main and imp points until I go out and the examiner closes the door .Passed Q. but still I asked about vision .....Wenzel always says that but we still ask !!!!!!!!!! ) Management Mr x ..

friends? Do u work? (I cannot remember the exact answer but nothing specific) -Health in general? Sleeping? Mood? Fine -Any chonic illnesses? Any medication? Smoking? No ...all of them were normal. blood tests and TFT and others ( I cannot remember the exact ix) . -Is the pain always there? No..She came today for the results.. we have received the results back and I am pleased to tell u that all of them r normal . clean and tidy -What about ur family.Anything relieves the pain? When I open my bowel or pass flatus -Anything worsens or brings up the pain such as certain food? yes when I eat certain food like broccoli and also red wine... Task\Take a focused hx... sigmoidoscopy.(I cannot remember the answers in this case including other pain questions like the severity but it was typical of Irritable Bowel Syndrome as in the previous recalls. History -Hi Mrs X.. D. it is every now and then -Does it travel anywhere else? No . is that fine with u? Yes.This means that u do not have any organic or serious illness but I still need to ask u few question to try to find the cause..DX and management In this case I tried to ask a little bit about the pain and constipation and to focus more on the social hx.colonoscopy.) -What about the constipation? (Again I cannot remember the details) -Do u have any diarrhoea in between? No -Do u use any laxatives? No -Can I ask u some personal questions? Yes -How is the situation at home? I am married and I have 2 kids (I think teens) -Any financial problems? No -R u happily married? Yes -Any problems with the kids? No but I always like everything to be perfect at home.Alcohol? red wine ( I think with evening meals) .

It is not cancer and it does not lead to cancer so please do not worry a lot about it.. This is not serious at all . .)..Referral to specialist is not enough.. (Here the bell rang and I did not tell the pt about the red flags.. It seems that the most likely cause is a condition called Irritable Bowel Syndrome. Task\ explain the condition to the pt and management.Some people used recreational drugs. relatives on special diet or cancer? No Management Mrs X. constipation and s.. reading materials. Other causes could be Celiac disease but it is very unlikely and we can do some screening blood test for it.it comes and goes and it may disappear for years. High fibre diet and plenty of water is imp.. This condition is chronic . (Here I really did not know what else to say about the D..... Try to be less than perfectionist. For medication I can prescribe u some medication such as mebeverine and peppermint oil but these medication is to control the symptoms and not to treat the condition. review!!!!!!!!) AMC feedback – Constipation -PASSED Q..our body can respond in different ways ( I am not sure if we should say that here). diarrhoea.and please try always to stay away from the laxatives as it can cause lazy bowel in the future. I can refer u to dietician if u like..16\ (The famous lymphoedema case) A 50 something woman came to ur GP clinic complaining of swelling in her left arm and forearm (I think the hand was not involved.. She has a hx of breast cancer years back and she was treated with mastectomy and axillary clearance followed by radiothearapy... It is not treatable but controllable condition however we still have a lot to do about it The most imp thing in the management is life style modification and preventing the contributing factors so try to avoid the causative food such as broccoli and red wine and try to make a diary and write down the food that can worsen the symptoms..Also a photo was provided)).. have u ever used them? No -any family hx of similar problems.DX in this case!!!!So I just continued my management and the examiner was just listening without any word. Also relaxation is very important to relieve the stress such as yoga and meditation.DX as I had not read in the previous recalls about a D.Have u ever heard about Irritable bowel syndrome? No Well the bowel of some people r sensitive to some external and internal stimuli such as certain food and stress coz our mind and body r connected to each other and when our mind under stress ..t..This will lead to different symptoms such as pain .

-Use emollients to moisturize the skin.. To prevent infection. also massage and try to keep ur arm elevated.veins and lymphatic vessels which carry a type of fluid called Lymph from the body back to the blood and these vessels r connected by lymph nodes( I drew that to the pt. Insect bite.The aim of the treatment is 2 things..so we need to do some tests such as some blood test as tumour markers.. Have u ever heard about it? No Well Mrs X. This treatment is usually successful however we still have surgery as a last resort.So I told the examiner that once I watched that on a TV report about 2 women. Lymphoedema occurs when the lymph accumulates in the body due to destruction or blockage of the lymphatic vessels. Firstly is to reduce the swelling and secondly is to prevent infection as the skin here is very liable to be infected. our body composed of three types of vessels ... most likely u have a condition called lymphoedema.). -Take care with nail clipping or hair removal. -Always wear gloves when working in the garden or washing dishes as the skin can easily get injured. To reduce the swelling.Explanation Mrs X. we need to use compression bandage day and night.arteries . physiotherapist... In ur case it might be due to the surgery itself and the clearance of the axillary lymph nodes in the armpit or it could be due to the radiotherapy or less likely due to recurrence of cancer itself..The physiotherapist will help u with that. -Do not let anyone to measure BP in this arm or to give u any injection or to take blood.(here the examiner was very surprised about this info and he asked me what type of surgery. nurse and me as ur GP). one in the US who was treated conservatively and the . it is important to follow certain tips: -avoid sunburn.. I really did not know what to say coz I just know from the course in the VMPF that there is a surgery .. (I cannot remember if I told the pt about referral to vascular surgeon for lymph angiogram to confirm the dx and I am not sure if this test is available or not or if it is right to mention it so please check this) For the management.. I will refer u to lymphoedema clinic and we will work as a multidisciplinary team (specialist. Other causes of this swelling r DVT (a clot in the vein) and infection.. CT scan to detect any recurrence and Doppler U\S to exclude DVT.

. however do not rely on the answers of the recalls completely as we may forget to write important and vial things..I tried to remember and write whatever I could. ....The role players did the same ..Actually they neither give u hints nor mislead u .... -I believe the stations in the exam were in the following order: 1....... .....Wenzel so much for his great and priceless efforts.as u can notice we had 5 cases from the book although they were a little bit modified.So the examiner nodded his head and said “ok maybe it was due to?!!!”I did not understand him) I forget to tell the pt about red flags and if there is any redness or signs of infection to come back immediately for antibiotics.I do not know what he wanted to hear from me .. -my exam was in Brisbane... Recurrent falls. -I would like to say a big thank you to the staff and all teachers of VMPF long course. -Please study the AMC book very well .. I finished this case earlier and I asked the pt if she has any further questions. she again asked me if it could be cancer and I repeated the same answer. 2... -Also I would like to thank Dr. The examiner here who was a very nice one asked me again to summarise my management so I repeated the same answer but he asked what else and I repeated the same things..Actually I did not lie and I really watched that before.Always compare the recalls and choose the best answer.... -Thank u to the previous candidates who wrote the recalls for us as these recalls were a vital element to study in order to pass this exam.This is the only case that I waited outside!!!!!!!!!! AMC feedback – Lymphoedema \upper limb -PASSED Dear colleagues..But always listen well to the role player and his concern and questions and answer accordingly.second one in Sweden who was treated by surgery..The examiners there just sit and listen to u. Headache-tension (paeds).Then we chatted a little bit then he asked me to wait outside.

. ....... 10. 5.. Leg cramps on exercise....... Constipation (Not sure) 15...... Pain in the chest .... Rest station. Dementia of Alzheimer type...... 20. Vault prolapsed after hysterectomy (O&G). 19..... Diabetes type 1 juvenile-counselling (Paeds). Gastroenteritis (Paeds)(not sure) 18.. Rest station. 14..... Rest station.....back and shoulder(not sure) 17. 9..... 8...... 4.... 12. 13.. Major depressive episode-post partum phase-.... 7... GOOD LUCK FOR ALL.... Post operative oliguria (not sure) 16..... Investigations during pregnancy (O&G) 6..... Primary infertility (O&G). Asthma.3........... Aches and pains........... Rest station. Lymphoedema\upper limb. 11.

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