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A 50yo man complains of blurred vision. Past hx: by-pass surgery 2ys ago, hypertension, DM, medication taken: Metformin, enalapril, simvastatin, aspirin – 100mg o Task: hx, ask for physical examination results, Mx. o Further details from consultation: 1. hx: there are other 3 episodes during last week persisting for 5minutes. No weakness of the legs, no sensory loss anywhere. The role player keeps on telling me that may be she needs to change her glasses. The blurred vision was like a curtain coming down on the right eye and she couldn’t see anything for 5minutes. No smoking, no alcohol, 2. on examination: pulse: regular, on right carotid artery – carotid bruit is present. Neurological: normal. Fundoscopy: normal. 3. Mx: • Admit to hospital, looks like TIA, do Ix: Doppler US of the carotid , CT, blood for lipids, cholesterol, FBE, ECG • Treatment depends on Ix results. 4. Qs from the examiner: • what are you expecting to see on CT scan? • Why do you order it? • What medication are you going to give? • AMC feed back: Visual disturbance Station two: cellulitis of the leg. A 65yo woman presents with a swollen sore right lower leg for 2 days (picture provided). o Tasks: 1. hx 2. examine the lower limb 3. advise about Mx. o Further details: 1. picture: diffused redness on lower limb, no ulceration, no clear margins. 2. on Hx: last night she noticed small patch of redness, and in the morning this redness had increased, became itchy and painful. No obvious injury, no hx of DM or HT. Two days ago she was doing gardening and thinks she injured herself with a branch. 3. On examination, Tº: 38.6, other vital signs are normal. Inguinal lymph nodes are palpable and tender. Pedal pulse presents. Sensation is normal. Others are the same as the picture. 4. Ix: FBC, blood culture, blood sugar, wound swab 5. Mx: • PC + flucloxacillin iv (may need admission)
65yo man who is travelling overseas soon. 25yo man. perform physical examination. Mx. Is the murmur systolic or diastolic? 2. cardiovascular system examination(a real patient with heart murmur). (redness in tympanic membrane and some crystal substances deposits on the lower part of the ear drum)An otoscope and a tuning fork are on the table. explain the condition 3. who is a truck driver. o Tasks: 1. 2. 716 for otoscopy and Rinne test and Weber test. he was told by other doctor that he had a heart murmur but he is asymptomatic. perform physical examination 2. what’s the Dx? AMC feed back: cardiac murmur Station four. Explain CT (see AMC book 303) to the patient 2. what would be the other management? AMC feed back: cellulitis of lower leg Station three. AMC feed back:cholesteatoma of right ear Station five. No discharge. Mx: • Antibiotics for two weeks or longer? • Recheck hearing test • Refer to audiologist for audiometry • Refer to ENT Dr for further Diagnosis and Mx if not response to antibiotics.cholesteatoma. AMC book case 136. o Details from consultation: 1. provide running commentary 3. presents to your GP clinic with ear pain for 3 days. further Ix . 3 episodes in the past with yellow discharge. Picture provided. o Tasks: hx.6. • Give tetanus vaccine • Elevate the leg • Bed rest • Review next day Qs from the examiner: • Which bacteria is most likely involved? • What antibiotics would you like to choose? • Apart from antibiotics. no need for abdominal and lower limb examination o Qs from the examiner: 1. p674. o Tasks: 1. Refer to AMC book page303. pheochromocytoma(CT scan and blood results provided). presents to GP for a pretravel check up. Dx.
o Task: 1. colonoscopy • Treatment will be according to the Ix results. on hx. The only positive sign is tenderness in the paravertebral area. He came today for the test results. No fistula. The patient had lost some weight and appetite. Mx: • Further Ix: stool culture and microscope. no haemorrhoids. solid nodule of about 1. Your next patient in your GP surgery is a 25yo man. 2. On examination. 1. ask examination findings from the examiner 3. GA and VS normal. AMC feed back: diarrhoea(recurrent) Station seven. advise on further Mx 3. Your colleague took a history and examined the patient and came to the conclusion that it was most likely a lump in the thyroid gland and arranged U/S. 3. Back pain. further Ix and Mx o further details from consultation. A 25yo man presents to your GP practice with back pain after lifting heavy box at work. explain condition to the patient (see patient education p118. The condition has been getting worse since yesterday. In the past. The U/S revealed a single. isotope scan and a fine needle aspirate for cytology. Focus GI examination showed some tenderness on LIF and PR showed blood in the glove. no neurological findings were present. diarrhoea was about 6 times a day. thyroid carcinoma. on examination. take further hx 2. who has been seen by one of the other GPs in the surgery two wks ago when he presented with a small nodule in the right side of his neck. o Task: 1. cathecolamines significantly increased. A 25yo man who is a computer worker presents with diarrhoea of 3 weeks duration. provisional Dx: inflammatory bowel disease 4. AMC feed back: Adrenal tumour Station six. write a prescription for the patient o important: to explain lifting technique o to write a medication the examiner gave a paper with the place for the name. 2. inflammatory bowel disease. address and a place to write the medication AMC feed back: acute mechanical lower back pain Station eight. aldosterone are normal. no steatorrhoea. answer patient’s questions o details from consultation: 1.4. but there had been some mucus and blood. he was treated with antibiotics but has had no improvement. ‘Backache’) 2.5x2cm with changes consistent with a papillary carcinoma in the right lower part of the thyroid . Other Ix: cortisol. This is the 4th episode in the past 3ys.
will she have any more fits? 4. secondary amenorrhoea . oestrogen: slightly low o Qs from patient: 1. A woman in the labour ward has just had a fit one hour after the delivery of her baby. how about chemotherapy or radiotherapy? AMC feed back: papillary cancer of the thyroid O&G: Station nine. o Further details: 1. o Task: 1. 20s woman’s period has stopped for 12 months. explain the Dx 2. One year ago the period gradually reduced and stopped. what will happen to me? 2. what’s the prognosis? 3. Only eat cereals and supplements. p672) AMC feed back: fundus less than dates Station eleven. how can I get my period back? 3. ask for physical examination results. The husband is with her and wants an explanation. Mx. is this epilepsy? 3. LH. future Mx: thyroxine and long term monitoring 5. can she breast feed the baby? AMC feed back: post partum eclampsia Station ten. answer his questions. o Qs for the patient: 1. Oligohydramnios – IUGR: Dx + Mn (AMC c133. BMI 15. what happened? 2. what’s about my fertility? o Mx: . Other examination results are normal. The seizure was controlled and now the mother is asleep. Dx.anorexia nervosa. The iodine 131 radioisotope scanning demonstrates a cold nodule in the same area. what about a future pregnancy and how to prevent it? 6. o Tasks: 1. jogging one and half hours per day. talk to husband about the condition 2. Post labour eclampsia. discuss the Mx options with the Patient. prolactin.gland. o Further details: first period: 14yo. The FNA confirms a papillary carcinoma. o Questions from the husband: 1. FSH: normal 2. TSH. what are you going to do now? 5. what’s the complications after surgery? 4. what will be the treatment? 2. o Task: hx. Your are a resident in a country hospital.
No family hx of epilepsy. further Mx AMC feed back: isolated speech delay Station fourteen. autism. The father has a hx of the same condition as a child. o Tasks: 1. o Qs: 1. psychologist for CBT and psychiatrist. advise mother about pregnancy and Mx about two children. can we give vaccine to young kids at 9mo? 2. focus hx 2. The mother is also concerned that her daughter shows some delay in her speech. This time temperature is 38. chicken pox and pregnant. • refer to audiologist for hearing test • refer to speech pathologist for assessment o Qs from the mother: 1. Her children had no symptom at the moment. this was the 3rd episode which is related to a high fever from 18mths. further hx 2. aged 9mths and 6yo. Can the audiologist diagnose epilepsy? AMC feed back: prolonged convulsion developmental delay Station thirteen. ongoing review AMC feed back: secondary ameonorrhoea Pae: Station twelve.5º. febrile convulsion. o Task: 1. Can it be epilepsy? 2.1. GP setting. The mother of a 3yo child comes to see you because her daughter has had a fit for 2 minutes. tell the mother about the condition 3. o Tasks: 1. o Further info: woman got chicken pox at 6yo. She has 2 children. 2. Tell the mother about the condition 3. The mother of a 3yo girl comes to see you because the staff at the childcare centre complained that the child has strange behaviour. Physical examination findings are normal. A woman with 10wks preg comes to see you because her 5yo niece had rashes on the back (picture provided: blisters on the upper body). see dietician. Mx: • Explain that is a febrile convulsion and reassure. how about pregnancy? AMC feed back: exposure to varicella Psy: . 2. Further Mx o Details hx from consultation: 1. provide Dx from a given picture 2.
AMC feed back: elevated mood assessment. adjustment disorder with anxious mood. . o Further details from consultation: 1. the daughter is 17yo. mania. o Task: 1.Station fifteen. She is currently working and looking after her sister who has just had surgery. o Tasks: 1. A woman of 40yo complains about chest pain for about 3 mths. She doesn’t have hallucination. mental state examination 2. The mother has no trouble with sleeping and eating. she suddenly begins to cry. summarise your findings to the examiner and 3. Mother thinks that the boy is a looser and doesn’t like him. discuss differential Dx with the examiner. take a hx 2. He hasn’t slept for a few nights and his performance is not good now. AMC feed back: psychosomatic chest pain Station sixteen. She also insists that she know sit’s a heart problem. left school and living with her boyfriend who is not working. Dx and Mx. She is also worried about her daughter’s future. 2. A 23yo university student claims that she has important information to report to the United States president. no delusion or suicidal ideas. All Ix including ECG and blood tests are normal. While you were talking to her and told her it is not a heart problem.
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