AMC Orals Brisbane 26th of July O&G

1. AMC feedback: Pre-pregnancy counselling –diabetic AMC assessment book condition 14 (P62, 102) 2. AMC feedback: Urinary incontinence/stress incontinence Scenario: A fifty-five year old lady comes to your GP complaining of urine leakage. She is overweight. Tasks: Take relevant Hx, ask examiner the physical findings and Mx. AMC assessment book condition 128 (p668, 688) When I stepped in the room, the examiner stressed the pt was obese. Then the role player gave the typical presentation of stress incontinence with the past 3 deliveries, one of which was aided by forceps. She denied past history of UTI, DM, HRT use and other aggravating factors like chronic coughing and constipation. Pap smear was up to date. Examination findings revealed atrophic vaginal change and positive pad test without cystocele, rectocele or uterine prolapse. Urine deepstick was unremarkable. Then I explained to the pt the likely diagnosis could be stress incontinence. However, mixed incontinence was not uncommon. I need to organise some investigations like urine C&M, BSL and urodynamic study. If the diagnosis was confirmed, there were several things we could do. I drew a picture and said the treatment options included pelvic physio, operation such as colposuspension to lift and strengthen the neck of the bladder. Life style modification was also very important, like weight reduction, prevention of chronic constipation and coughing. I would refer her to incontinence clinic. Before the bell rang, I also added local estrogen cream if there was no C/I. 3. AMC feedback: Urinary retention Scenario: Eighteen year old young lady comes to ED complains that she has been unable to pass the water for a couple of hours. Tasks: Take a relevant history, ask PE from the examiner and manage the case. When I went inside, there was a lovely young lady sitting in the chair. After introducing myself, I got to know her name was Anna. Me: When did it happen?


it started several hours ago. Me: I can see you feel uncomfortable. I turned to Anna: Anna. it looks to me that you have the genital herpes. It is gonna be a little bit sore. now I am comfortable now. 2 . No contraception. but I will do it quickly. Don’t know about him. everything was all right? Anna: No problem before Me: Has it happened before or is it the first time? Anna: The first time. Me: Have you ever been diagnosed with any STI or PID? Anna: No Me: Pap smear? Anna: No Then I turn to the examiner: Examiner: What do you want to know? Me: GA and V/S. I understand that you are in great pain. Thank you. Is that all right for you? Anna: Pls. especially Temperature. I am going to use a syringe to aspirate your water out from your tummy. I smiled and said to the examiner: Pls can I take the swab from the ulcer and send to lab? Examiner smiled: of cos you can. so do you want me to help in emptying the bladder now? Anna: I am fine. Me: Have you noticed any discharge from there or vagina? Anna: No Me: Before this episode. doc.Anna: Oh. any kidneys or bladder problems? On any medications? Anna: No to all the above Qs Me: Can I ask some sensitive Qs? Anna: Yes? Me: Are you sexually active? How long have you been with the partner? Do you have any other relationships? Do you use any contraceptive methods? Any similar symptoms for your partner? Anna: Yes. Me: What about your general health. Me: Any other symptoms: burning sensation when you pass the water before this? Tummy pain? Fever? Muscle soreness? Anna: No to all the above Qs. I feel sore in my private area and cannot pass the water. so let me help you to get relief first. three months. Examiner: all normal and Anna feels uncomfortable for you to touch the tummy. no other relationships. I have already taken the sample and sent it to lab. Pls talk to Anna what you are going to do. Me: Could you pls tell me more about your symptoms? Anna: Oh. Okay. you can see the ulcers and blisters around the vaginal area.

bring him here to see me. Paeds 1. but has had no diarrhoea. Father: What does it mean? Me: It may indicate the infection involving the water-passing system (I drew a pic). Do you reckon? Anna: That is fine. but if that is the case. What I am going to do is to refer your child immediately to the hospital. What medical staff will do in the hospital is to take the clean urine out directly from the bladder (I pointed the bladder in the pic). I strongly suggest you to have it done. Pls talk to him and if possible. Dipstick of urine (urine bag specimen) showed protein. This is called Superpubic 3 . Tasks: Talk to the father about the management. Since it started several hours ago. whichever comes later. Father: Okay. Then we have further Mx for you. it will be less frequent and less painful. She had vomited twice. from 18 years old or two years after being sexually active. Your next patient is 18 months old girl. Anna: Thank you.4 now. There are some abnormal findings. will it happen again? Me: It may recur. pap smear. As you know. there are lots of bugs around the private area.Me: That is good. who has been brought in by her father because she had been unwell with fevers for the past 48 hours. nitrites. Also HPV vaccination is free for her. Also it is very important for me to suggest a full STI screening test. Anna: I will. So for the best interest of you. She is all right. I can prescribe you some anti-viral mediation and pain relief gel. but what about my bf? Me: It is recommended too for your bf to have this screening. You can use them for a couple of days. like safe sex. so what will you do? Me: Because we do not want to miss the possibility of infection as it is for your daughter’s best interest. AMC feedback: Febrile toddler with slight pyuria Scenario: You work in GP setting. As this condition itself is transmitted by sex. but there is also the possibility of contamination by the outside. doc. Tell me what is the problem? Me: We’ve got your daughter’s bag urine test back. So doc. Then I talked about some other things. leucocytes. Me: How is your daughter now? How is her eating and drinking? How many nappies have you changed so far? How about temperature now? Any rashes on the body? Father: The Tm is 37.

C: I want to focus on abdominal examination. It is gonna be a little bit sore for your child. ask physical finding and manage the case. The specialist may also consider the further Ix for the child after the recovery. On palpation. E: he looks miserable and is in pain. Then I explained the condition to the father. the right scrotum is quite tense. most probably your child will be put on antibiotics for a couple of days. Me: Any Qs? Father: No. Pls do not worry. The bowel sounds are present. groin hernia and scrotum. But. The sample will be sent to the lab for culture and other tests for the purpose of medications. Tasks: Take relevant history. looking for any mass. After greeting the father. I said that you were a good father and brought your child to hospital at the early stage. peristalsis. C: How about GA and VS. in the hospital your child will be very well looked after by the specialist. I understand. VS are still within normal range. I was told the abdominal pain started a couple of hours ago and the kid felt quite sick and looked miserable. 4 . The father was quite concerned about his son’s fertility. then the specialist will make the decision what to do at that time. Your kid will have good chance to recover fully. The urgent admission and surgery would be needed to restore the blood supply and to fix bilateral testes to prevent recurrence for both sides. His temperature was normal and bowel and water worked fine previously. then your daughter can go back home after SPA. which means contamination. but it is very quick and you can accompany her. like U/S and Miturating cystourethrogram (I drew a pic to explain how MCU would be done). the nice lady asked me how you went for physical examination. you have explained everything. and the testis is high and horizontal. if the bag urine test this time is false positive. As I have mentioned. He was healthy before and was not on regular medication. Father: Will my child need admission? Me: It depends. an 8 year boy was brought in by his anxious father because of acute abdominal pain and feeling unwell.aspiration. E: there is a right scrotal swelling. saying the affected testis was lacking of blood supply due to twisting. 2. When I turned to the examiner for physical findings. Father: Okay. I start from inspection. The experts would try their best to save his testis. If that is the case. AMC feedback: Torsion of testis Scenario: ED setting. if SPA sample is positive.

AMC feedback: Bulimia nervosa . Psych 1. bones. especially skipping insulin potentially might endanger her life. Specifically. otherwise he must be very angry at me. stomach. His son was crying and holding his breath for few seconds after his finger has been injured by the car door. which was a kind of eating disorder. dietician and psychiatrist involvement. also tried to control the weight by using laxatives. It would not be harmful to the child’s brain and his development. AMC feedback: Breath holding attack Scenario: An anxious father came to your GP clinic concerning about his 2-year-old son’s condition. I also took a little bit history. teeth and food pipe. blood system. 5 . Then I mentioned family meeting. Dx and explain to the father. I explained she got Bulimia nervosa. She said her periods were ok. It is very common in young people. I explained to the father that what to do in case it happened again. doing well with her colleagues and parents. pls do not tell my GP about this. period. She was a hair dresser. People with this condition had overvalued idea about eating and body image. Her eating habit also affected her heart. Tasks: take relevant history from the father. as some people tend to use this way to cope with the stress in their life. After taking the history. I answered ‘the conversation between you and I today will not be out of this room’. skin. 3. I convinced her that what she had done was harmful to her health. (No history taking) As soon as I greeted her she said: doc. You got to know this girl had binge-purge eating habit. Gave the advice on how to manage in the future which all could be found in the patient education. I made the Dx as breath holding attack and explained to the father that it’s kind of temper tantrum. I left earlier.Both the father and examiner did not ask any questions. Tasks: explain the diagnosis and its effect on her body to the pt. CBT would help her to correct the overvalued idea about the eating habit and body Scenario: A young girl with DM type 1 was going to be discharged from ED after being treated for DKA successfully. She had no suicidal idea and had not used any drugs. What about laxatives? I told her it could cause electrolyte imbalance and also resulted in constipation from a long run. and manage the case. CBT or sometimes some medications might be needed. The nurse required you to talk to her as she found the girl skipped the insulin purposely. It was not epilepsy which the father was quite concerned about it since his uncle had it.

I noticed this lady lacked of eye contact and looked at the ground. At this moment. She drank 1-2 glasses of wine everyday(I specifically asked the glass size and told her about the safe level). sleep hygiene and psychiatrist review. Then I counselled her. Med & Sur 1. Then I asked the typical depression Qs. Then talked about relaxation techniques. explain CT to the pt and manage the case AMC assessment book P 303-307 6 . Past physical hx and mental illnesses were negative. I began to know this was a psychy case. I mentioned the follow up and written information. My tears were almost out when she repeated: I am very unhappy. So I spoke very softly and the examiner had to move her body close to me. all negative. I think maybe after this operation I will feel better. AMC feedback: Adrenal tumour Scenario: A middle aged lady was found to have a 5cm size abdominal mass on her CT and her BP was confirmed to be elevated. early waking up. Me: Pls could you tell me why you want to have this done? Roleplayer: I am unhappy. After that. She had no delusions or hallucinations. Pls notice that referring to the specialist is not enough. very unhappy. At last. Tasks: Counsel her. saying the possible Dx could be depression. I could not see whether she was pleased or not with my performance. lack of interest of life. Then I screened her for grief Qs. When I stepped inside. ask examination findings from examiner. She had the following features: feeling down for over two weeks. you must state the reason for that. sex drive decreased and no suicidal ideas/plans. Tasks: Take relevant Hx.Then the role player asked: what is the difference between a psychologist and psychiatrist? I answered: both of them can do the talking therapy. Other stresses: father passed away several months ago. I realised I forget to say that she need to be assessed by the psychiatrist before being discharged! 2. mother also passed away long long time ago and stressful job. She was a very good actor with Queen’s accent. which is CBT but the psychiatrist can also prescribe the medications. Me: Why? Roleplayer: My husband is going to divorce me. She had no features of anxiety. AMC feedback: A request for bilateral breast reduction Scenario: A 28 yo lady wants to have breast reduction operation done.

ankle swelling. no displacement of apex beat. no JVP elevation. Further Hx included: profession (he worked in a timber shop). lasting about 10 minutes. AMC feedback: Shortness of breath Scenario: A 45yo man complains of SOB for 3months. you had a tumor in the adrenal gland. bone scan and some blood tests to exclude other DDx such Conn’s disease and Cushion syndrome. We need to order further investigations to confirm the diagnosis. There were no signs for Cushion syndrome. the examiner immediately asked me to talk to the pt (time controlling was very important for this case as I noticed the examiner helped to shorten the time for PE). visual problem. we call pheochromacytoma 10% tumor. Then I said. breath sound…. trachea. α blocker and ß blocker. general heath are FHx are negative. smoking (two packs for over 10yrs). PHx of liver and kidney problems. no irregular pulse. After finishing this. no fundi change. I stressed the point that α blocker should be first! 2. Then I asked CVS (chest pain. catecholamine. how many pillows at night. In medical field. This pt had several episodes of headaches and palpitation. Most likely it was pheochromacytoma which might explain your symptoms. Tasks: take relevant Hx. based on the clinical features and CT scan. Then I turned to the examiner asking for PE. Her bowel and water worked fine. The examiner immediately asked me: which system you want to know? I said: Respiratory system. sputum. He said a lot of things. vocal fremitus. After I greeted the role player. She was previously healthy and family history was unremarkable. without obvious trigger factors. travelling Hx). the only info I grasped was ‘ the breath sound disappeared at the left lower chest’. no ankle oedema. Also if it is the case. The pt did not complain of skin colour change chest pain. 10% spreading outside adrenal gland. you would be given some medications prior to operation.Actually all of his words did not get into my mind! At that moment. I then drew a pic talking about the pleural effusion and 7 . tactile fremitus. of sudden onset. First I screened him on PE Qs (cough. such as urine VMA. PE from the examiner and give the Mx. all negative. tummy pain or weight loss. ankle swelling). no crackles in lung fields. And urine deep stick was negative. 10% malignant and 10% bilateral.(Pls read the book carefully as all of the answers are between the lines in the book). Examination findings: high BP. I started to explain the CT scan briefly. no abdominal mass palpable. 10% familiar. Mx: refer to surgeon for operation as the size reached 5cm. which was 180/110. all negative. loss of consciousness. dizziness.. SOB. no abdominal bruits.

For people with dementia. If he cannot cook. Her father was Dx with Alzheimer’s disease by the specialist recently. we can put him on some meds. I understand it must be very stressful at this. AMC feedback: Dementia of Alzheimer type Scenario: A middle aged woman comes to your GP clinic. Ex findings and Mx 8 . We have aged care assessment team. We need to assess him. if that is the case. Occupational therapists will assess your father safety issue. we will arrange the people to help on that. Me: Okay. But pls do now worry. I want to talk to your father. whether he is going to nursing home. we will look after your father together. AMC feedback: Weakness in left arm and leg Scenario: 65yo female comes with left arm and leg weakness from this morning comes to your GP clinic. they may have depression. Geriatrician. Sometimes we also call depression pseudo-dementia. It is too early to say at the moment. I need to assess him. It includes a lot of people who are going to look after your father together. steps in the yard and other modifications at home. to initiate the assessment for your father. he does not drive. if he is not able to wash clothes. the specialist will explain more to you. Daughter: Will I inherit the dementia from my father? Me: It is difficult to say.offered the referral to hospital for further Ix. Can I ask does your father drive? Daughter: No. I need to do MMSE on him. My role as a GP is to regular follow him up. But normally it happens at a very young age. The bell rang on my last word! 3. Can my father have depression? Me: It is possible. I also mentioned the possible Dx including the nasty things. Pls do not worry. Regarding this issue. Social workers are also involved. respite care. the bright lights at night. 4. After assessment. The most important Ix was called pleural tap (then I explained in the pic). the specialist will assess your father’s health and also possible medications. whether he need walk stick or wheel chair. we will arrange meals on wheels. what level of support he need. there is a very rare type which may run in families. Tasks: Ask proper Qs. Physiotherapists will assess your father’s mobility. I will come and visit your father. residential care or private hospitals. Tasks: Listen to her concerns and answer her Qs. rails at home. Daughter: I do not want to look after my father. as you know I am very busy at work and I do not have a good relationship with him. Her relationship with her father is tense.

other Vitals (-) Cranial nerves (-). visual problems? Any tingling sensation? Have you ever had stroke? Ever had this before? Any family members with CVD. You take warfarin? Why ? Have you had something called AF? Your heart must be irregular? How long on warfarin? How often do you check INR? When was last time? Months ago. advice accordingly. active or reactive (-) Upper and lower limb motor sensory and tone. Also INR need to be done immediately. in your case. The patient was sent to you by specialist who already prescribed Carbamazepin. female courier who is going to get married came to your GP setting for some advice regarding his epilepsy. The first thing is to go to ED and have a CAT scan done. reflex: all decreased at the right side I want to find out plantar reflex: R down. could be clots.My Qs were as follows: How did it start? when you went to bed last night. Depending on the results. But we need to organise some investigation to find out underlying causes’. and both are possible. Her appetite and exercise lever were the same and did not feel stressful. The role player volunteered that she had lost 6kg over the last 3 months. Explanation: At this station I dominated the conversation. I talked to the pt: ‘I am sorry to tell that you may have stroke. Regarding your weight change. docs are going to Mx it. I asked a few more Qs.o. AMC feedback: Epilepsy – idiopathic Scenario: 25 y. Then turned to examiner: Pulse rate is irregularly irregular. stroke could be bleeding. What was the finding? 2-3 Well. 9 . The bell rang! 5. heart attack. stroke? What are known medical conditions? Any known medications? I take warfarin. AMC feedback: Anaemia AMC assessment book condition 111 (page 576. AMC feedback: Chest pain AMC assessment book condition 065 (P348. L upper going Then I told the examiner: upper motor neuron lesion on the right side. I am not sure. I am going to tell you what is stroke. completely normal? Any difficulty in talking? Any headache. AMC feedback: Abdominal pain (Acute) AMC assessment book condition 140 (P678. Tasks: Explain condition. no carotid bruits Pupil equal. I kept talking and talking according to the draft in my mind. 728) 7. Pls do not get upset about it. 356) 8. 596) 6.

Epilepsy is the abnormal electric discharge in the brain. Need to change the job. • If you are not happy with one station. • On the big day. but it is possible to drive the private car after being further assessed by the neurologist in the future. so need to tell the future doc and pharmacists beforehand 4. They will lead you through easily if they want to. Do not overeat. which is a precious treasure for our future career. I mentioned a lot of figures as I felt it might make the pts feel better if knowing his/her specific condition is common. Be careful of the interactions with food. 3. but also for the family members. this is a patient-centred exam. He has trained us to be as local graduates. Not only for herself. better off the alcohol. 3% risk for the baby if one parent is idiopathic epilepsy) like folic acid and morphologic U/S. During the exam. I brought all pre-pregnancy advice for epileptic women here (of cos I mentioned the figure again. a light meal before the exam is important. It is very common in our society. climbing. like grape juice. Action plan will be given for the acute attack. Offer to see the partner and the plan for future pregnancy There was time left. who cares one station!’ It is really very effective! • Good luck. A lot of safety issues mentioned: swimming. keep going. The written info will be given regarding this. • During the 2min reading time. Medi-alert/bracelet 8. making the role-players happy is of utmost importance. avoid stress and mood swing. Be careful of the interactions among the medications. Follow up: especially initially drug concentration need to be monitored 9. • This was a great exam and the following Thursday after this exam was the happiest day in our lives! We believe you will have the same feeling in the future. so keep going. Luckily I tried to remember all of these figures before the exam) Several issues I have mentioned: 1. 5. I use the words by Dr Wenzel ‘you are allowed to fail 4 stations. Comments: • We would like to thank Dr Wenzel from the bottom of our hearts for his support and help to all IMGs. • Do not study the day before the exam. remember to cheer yourself up after it. 6. • Please remember Dr Wenzel’s words. Have good sleep everyday. 1 in 100 (in this exam. travelling…… 7. Take the medication regularly 2. Safey and job. not be able to be commercial driver. A warm shower and a good sleep are the best warm-up for the big day. which causes the abnormal movements of the body. so the roleplayer asked more about the future pregnancy. try to make a good plan for the counselling before entering. diving. • Be well prepared before the exam and you will feel confident on the day. everybody! 10 .

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