Wednesday Clinical tutorial 5/11/2008 by Dr Matthew CAI 12 cases, Not to be published .

Most of these cases may will be repeated in coming AMC real exam. They are highly valuable cases. Wednesday Clinical tutorial 29/10/2008 by Dr Matthew CAI Case 1 Mr James Brown, 63 years, Retired teacher saw you 1 week ago complaining of dyspnoea on exertion, and you noted pallor. Hb 103, iron deficiency. No obvious source of blood loss. Barium enema ordered, looking for occult GIT blood loss. ―Several sigmoid diverticulae present. Intraluminal mass in ascending colon, with neoplastic appearance‖ Mr Brown has come for the result of his Barium Enema. Task : Manage this patient and answer her questions Case 2 Mr Lee‘s mother is a patient of yours in the local Nursing Home. She has a 5 year history of Alzheimer‘s Disease, is now bed fast, severely demented, doubly incontinent, with several large pressure areas which will not heal. You recently commenced her on Morphine for relief of pain prior to dressing changes. He is a strong opponent of euthanasia, and is concerned that, although his sister gave consent, that you are giving her Morphine to hasten her death. Task : Manage this patient and answer her questions Case 3 Tracy Smith aged 6 months Daughter of Peter, a young man who has been a patient of yours for many years. Peter has custody of his daughter, and lives with his parents, who are also your patients. Peter has brought Tracey to see you urgently, because he just found her lying on the floor, beside her bouncer, not breathing. Tracey was recently in hospital with presumed apnoea, and has been using an apnoea alarm. Tracey is pale, unresponsive, and breathing quietly. She has a large haematoma on the side of her face, with no Abrasion Task : Manage this patient and answer her questions

Case 4

Mr Peter James 33 yrs old unemployed, Peter has been a patient since childhood. He has a history of intravenous drug use, but is now on Methadone maintenance. His new girlfriend, Eva, also has a history of Heroin use, and has been on Methadone before. She has been injecting Heroin again for several months, and has just discovered she is 14 weeks pregnant. Peter wants her to commence Methadone as soon as possible, and Eva is apparently in agreement with this. Peter has come to speak to you to see if you can help. Task : Manage this patient and answer her questions

Case 5

A 25 year old lady comes to see you as a GP , she is 6 weeks pregnant, but she is a university student in her final year, she has no plan to raise up a child, and she is asking about how to do abortion Task : Manage this patient and answer her questions

Case 6 A 57 year old man comes to see you as a GP , she has CT coronary scan done and now return to ask you some questions Task : Manage this patient and answer her questions Case 7 A 25 year old lady comes to see you as a GP , she is 6 weeks pregnant, and she is a university student in her final year, she has a swelling lump in her neck. Task : 1 Examination 2 Manage this patient and answer her questions Wednesday Clinical tutorial 22/10/2008 by Dr Matthew CAI Case 1

This is 65 year old man comes to see you with Tremor, please perform a Parkinson disease examaination Case2 This is a 78 year old man with eye pain , please do a eye's examination Case 3 This is a 23 year old man with elbow pain, please take history and perform an elbow examination Case 4 This is 65 year old man with right leg pain, do an examination Case 5 This is 25 year old man have a MVA, now neck pain, please do neck examination Case 6 Shoulder examination case 7 hand examination Case 8 Thyroid examination Case 9 Neurology and CN Case 10 Back and hip examination Case 11 22 years' old young man came with dizziness to you. His left eye is funny and he is feeling clumsy on one side of his body. he also had problems with speaking and drinnking water. your task is to take a focused brief hisotry and diagnose the case and answer the examiners questions

duration: one and a half year family history: hypertension Examiner show MRI DDx: multiple sclerosis? migraine? Case 12 nine years old girl diagnosed with insulin IDD six months back. how we can approach it in more professional way? Wednesday Clinical tutorial 15/10/2008 by Dr Matthew CAI case 1 A 74 year old male is referred to the ED by his cardiologist. He is fatigued and complaining of moderate headache the past week. manage the case. because in the city they had all facilities. Despite a regime of atenolol 100 mg and lisinopril 80 mg. you do the examination. you are GP. she is avoiding her father. BPs are consistently 150s/80s. mother is saying that she went to see her divoiced husband and when she returned she is having these rashes. He has been taking ibuprofen 200 mg 2-3 x/day and has 5/10 scale headache now. she is having rashes over vulval region. His mother had hypertension You are the RMO and starting interview him and noticed that something is not right while you are taking history Task: 1) Take the relevant history. it is obviously child abuse. 2) Do a physical examination 3) Tell the examiner what investigations you want to do. . mother is living with her boyfriend. taks: manage IDD in country side and answer the dad's quesiton what are the difference between IDDD management in country side and in city? case13 5 year old girl is brought by her mother. Family relocated in the country side. The patient is post MI 3 years ago and has been chest pain free on clopidogrel 75 mg daily post stenting a year ago. there is rash present. Cardiac echo is normal and LDL is 68 on Vytorin 10/40 mg. no history taking. father is worried about management.

Further history 2. She also insists that she know it‘s a heart problem. Case 5 A woman of 40 year old woman complains about chest pain for about 3 months. tell the mother about the condition 3. advise mother about pregnancy and Mx about two children. While you were talking to her and told her it is not a heart problem. further Mx Case 4 A woman with 10wks pregnant comes to see you because her 5yo niece had rashes on the back (picture provided: blisters). aged 9mths and 6yo. She is currently working and looking after her sister who has just had surgery. Further Management Case 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. Task: Take the relevant history. o Task: 1. Tell the mother about the condition 3. she suddenly begins to cry. She has 2 children. Physical examination findings are normal. All investigations including ECG and blood tests are normal. What is the underlying etiology? 5) Management plan Case 2 GP setting. What is the underlying etiology? Management plan . Give your Differential. The mother of a 3yo child comes to see you because her daughter has had a fit for 2 minutes.4) Give your Differential. Do a physical examination Tell the examiner what investigations you want to do. provide Dx from a given picture 2. o Tasks: 1. focus hx 2. o Tasks: 1.

He is fatigued and complaining of moderate headache the past week. You are not happy to do so without seeing the patient. Mrs. Instead. Cardiac echo is normal and LDL is 68 on Vytorin 10/40 mg. He has been taking ibuprofen 200 mg 2-3 x/day and has 5/10 scale headache now. why he got infected. Your task is to explain to his wife about your opinion and answer his wife questions. Case 7 Short case You are Smith‘s family doctor. why did you send him to the small hospital? The consultation became very difficult to continue. Tasks: 1. He was doing well until yesterday developed a high fever and rigor. He was unable to attend your surgery because he was too sick. The wife was angry and questioned how the operation was performed. Mental state examination 2. his wife came to see you. BPs are consistently 150s/80s. He hasn‘t slept for a few nights and his performance is not good now. Cases will be distributed in classroom Wednesday Clinical tutorial by Dr Matthew CAI yet to decided case 1 A 74 year old male is referred to the ED by his cardiologist.Case 6 A 23 year old university student claims that she has important information to report to the United States president. Summarise your findings to the examiner and 3. Discuss differential Dx with the examiner. You referred Mr. Wednesday Clinical tutorial by Dr Sanjiv Shed 17/09/2008 and 8/10/2008 Wednesday Clinical tutorial by Dr Bryony Stanton 24/09/2008 and 1/10/2008 Dr Sanjiv Shed is AMC clinical examiner. His mother had hypertension You are the RMO and starting interview him and noticed that something is not right while you are taking history Task: . Despite a regime of atenolol 100 mg and lisinopril 80 mg. Smith is requesting some antibiotics for a quick fix. Smith who is a 40 year old CEO in a large company to hospital for vasectomy two days ago. There was some wound discharge according to his wife. you may see him while you are doing your real clinical exam . The patient is post MI 3 years ago and has been chest pain free on clopidogrel 75 mg daily post stenting a year ago.

tell the mother about the condition 3. o Tasks: 1. focus hx 2. What is the underlying etiology? 5) Management plan Case 2 GP setting. Task: Take the relevant history. All investigations including ECG and blood tests are normal. provide Dx from a given picture 2. She is currently working and looking after her sister who has just had surgery. 2) Do a physical examination 3) Tell the examiner what investigations you want to do. She has 2 children. Physical examination findings are normal. she suddenly begins to cry. Do a physical examination Tell the examiner what investigations you want to do. Case 5 A woman of 40 year old woman complains about chest pain for about 3 months. . While you were talking to her and told her it is not a heart problem. o Task: 1. Tell the mother about the condition 3. Further Management Case 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. 4) Give your Differential. Further history 2. advise mother about pregnancy and Mx about two children. o Tasks: 1.1) Take the relevant history. The mother of a 3yo child comes to see you because her daughter has had a fit for 2 minutes. She also insists that she know it‘s a heart problem. further Mx Case 4 A woman with 10wks pregnant comes to see you because her 5yo niece had rashes on the back (picture provided: blisters). aged 9mths and 6yo.

Discuss differential Dx with the examiner. Task: 1) Take the relevant history. why did you send him to the small hospital? The consultation became very difficult to continue. You referred Mr. Mrs. Instead. You are not happy to do so without seeing the patient. What is the underlying etiology? Management plan Case 6 A 23 year old university student claims that she has important information to report to the United States president. He hasn‘t slept for a few nights and his performance is not good now. Smith who is a 40 year old CEO in a large company to hospital for vasectomy two days ago. He was unable to attend your surgery because he was too sick. Summarise your findings to the examiner and 3. why he got infected. . There was some wound discharge according to his wife. His mother denies any other major problems. Your task is to explain to his wife about your opinion and answer his wife questions. Tasks: 1. Wednesday Clinical tutorial by Dr Sanjiv Shed 10/09/2008 No cases provided Wednesday Clinical tutorial by Dr Matthew CAI 03/09/2008 We will do the most recent cases: Sydney 2008 08 29 and Melbourne 2008 08 09 Case 1 (2008 08 29 Sydney) Last Friday You are an Emergency Intern working a late shift. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. The wife was angry and questioned how the operation was performed. Mental state examination 2. his wife came to see you. He was doing well until yesterday developed a high fever and rigor. Case 7 Short case You are Smith‘s family doctor.Give your Differential. Smith is requesting some antibiotics for a quick fix. You review an obese 11 year old child who presents to emergency complaining of pain in his right knee.

A woman in the labour ward has just had a fit one hour after the delivery of her baby. What is the underlying etiology? 5) Explain management plan to husband Case 4 (2008 08 09 Melbourne) A 29 years old lady comes to see you for routine prenatal clinic. The husband is with her and wants an explanation. Task: 1) Take the relevant history. She found her tummy was not growing any more.4) Give your Differential. she is 34 weeks pregnant and progress well previously. The FNA confirms a papillary carcinoma. Task: 1) Take the relevant history. 2) Ask the examination finding from examiner only given what you ask 3) Summarise your history and findings and provisional diagnosis. What is the underlying etiology? 5) Management plan Case 2 (2008 08 09 Melbourne) Your next patient in your GP surgery is a 25yo man. 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. The seizure was controlled and now the mother is asleep. isotope scan and a fine needle aspirate for cytology. What is the underlying etiology? 5) Management Case 3 (2008 08 09 Melbourne) O&G: Your are a resident in a country hospital. 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. she was G1P0 and very anxious about this pregnancy as her sister had still born at 35 weeks pregnant. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. solid nodule of about 1.5x2cm with changes consistent with a papillary carcinoma in the right lower part of the thyroid gland. Give your Differential. The iodine 131 radioisotope scanning demonstrates a cold nodule in the same area. He came today for the test results. The U/S revealed a single. 4) Give your Differential. .

G3P1 with D&C x 2 woman presented with a positive pregnancy test and vaginal bleeding. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. She is not using any form of contraception. What is the underlying etiology? 5) Management plan Wednesday Clinical tutorial by Dr Matthew CAI 27/08/2008 9 August 2008 AMC Melbourne Clinical Exam . Give your Differential. previous two pregnancies were miscarried. What is the underlying etiology? 5) Management plan Case 6 ( 2008 08 29 Sydney ) A 25-year-old. Otherwise she was well. She complained that she was badly vomiting every day for past three months. She smokes 20 cigarettes a day. she is university student and her period was stop 12 months ago.Task: 1) Take the relevant history. What is the underlying etiology? 5) Management plan Case 5 (2008 08 09 Melbourne) A 22 years old lady comes to see you for advise . She lives with her boyfriend in Sydney. Task: 1) Take the relevant history. She was depressive as her boyfriend saw her as ― an ugly fatty woman ― . and drink alcohol 3 glasses a day. 4) Give your Differential. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. She has no history of DM. She is trying hard to lose weight. 4) Summarise your history and findings and provisional diagnosis. 4) Give your Differential. She come to see you as a GP for prenatal check up and advise to stop her vomiting Task: 1) Take the relevant histor 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do.

The fingers are all in a slightly flexed position. and tense. enalapril. 18 year old university student. What is the underlying etiology? 5) Management plan Case 2 A 50 year old man complains of blurred vision. simvastatin. Now he is seeking your advise Task Interview Mr. Mr Smith accidently found Matthew was kissing his male friend in his bedroom. 4) Give your Differential.She complained severe pain of her right leg and felling general unwell. The distal hand and fingers are darkly discolored and cool. 4) Give your Differential.Case 1 A 45-year-old woman suffers severe complications during treatment for right pleural effusion. Task: 1) Take the relevant history. In his capacity. Now he came to see you as a GP to check his eyes Task: 1) Take the relevant history. Mr. hypertension and DM. it is blistered. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. He is taking medication of Metformin. and the nail beds are blackened. followed by sentinel nodes surgery. Mr Smith was so upset and has not yet talked with his wife. He has a good relationship with his son Matthew. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. which he believes is a sinful perversion . Smith found Matthew shows no interest in girls and has several male friends. She has received chemotherapy after the surgery. He has past history of by-pass surgery 2ys ago. She has history of right breast cancer. A change in her right hand is noticed. She . and the radial and ulnar pulses are not palpable. he has taken a hard line on homosexuality. Smith and advise him appropriate Case 4 A 65 year old woman presents with a swollen sore right lower leg for 2 days (picture provided). Picture will be provided. extremely swollen. aspirin – 100mg. What is the underlying etiology? 5) Management plan Case 3 Mr Smith is age 47 year old an accountant who is also an active member at his local church .

2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. 3 episodes in the past with yellow discharge. What is the underlying etiology? 5) Management plan Case 5 Cardiovascular system examination. no need for abdominal and lower limb examination o Qs from the examiner: 1. Case 7 A 68 year old man presented to your surgery after episode of right upper quadrant abdominal pain . which has resolved after 4 hours. Tasks: hx. This is the 4th episode in the past 3ys. (redness in tympanic membrane and some crystal substances deposits on the lower part of the ear drum)An otoscope and a turning fork are on the table. 4) Give your Differential. ask examination findings from the examiner 3. answer patient‘s questions. further Ix 4. take further hx 2. Case 7 A 25yo man who is a computer worker presents with diarrhoea of 3 weeks duration. others were unremarkable Tasks: 1. presents to your GP clinic with ear pain for 3 days. o Task: 1. provide running commentary 3. presents to GP for a pre-travel check up. Picture provided. perform physical examination 2. Mx. Clinical exam revealed blood pressure 160/100. No discharge. further Ix and Mx Case 8 . explain the condition 3. what‘s the Dx? Case 6 A 25yo man. Task: 1) Take the relevant history. Dx. who is a truck driver. Explain CT to the patient 2. In the past. he was treated with antibiotics but has had no improvement. 65yo man who is travelling overseas soon.has no Shortness of breath . perform physical examination. o Tasks: 1. Is the murmur systolic or diastolic? 2.

you will see all the cases below are very difficult patients. write a prescription for the patient 4. o Task: 1. There was bruising marks on chest wall. She has been married for five years with two children. she married to Robert who is a lawyer. he is non smoker and drink alcohol occasionally. George told you that this is normal for him. you may find hard to continue. He married to Julianne Robert with two children . To write a medication on an outside script Wednesday Clinical tutorial by Dr Matthew CAI 20/08/2008 This week we are focus on difficult consultation. He went to ED . He is not taking any regular medications. as he has same three years ago. During the exam. blood pressure was 150/95 mmHg. she is healthy Task Interview this lady and manage her appropriate Case 2 George Smith is 38 year olds man . Case 1 Barbara Smith is 38 year olds house wife. no neurological findings were present. he is well.he comes to see you because of chest wall pain. On examination. She comes to see you as a Gp for skin bruising and depression . but was discharged after a normal chest xray. otherwise were all normal Task: Interview this patient and manage him appropriate Case 3 . otherwise . let us show you the way to do it. ‗Backache‘) 2. explain condition to the patient (see patient education p118. He is wondering if you can offer him better medications to stop the pain.A 25yo man presents to your GP practice with back pain after lifting heavy box at work. she is non smoker and drink alcohol occasionally. The only positive sign is tenderness in the paravertebral area. advise on further Mx 3. She is taking OC pill . he played baseball three dyas ago and missed a catch the ball hitting to his right chest wall.

Task: Interview this patient and advise her appropriate Case 4 Lisa Smith is 38 year olds house wife.she comes to see you with her 7 years old daughter Tara because of her daughter leg laceration wound. He has very limited skill of writing and reading. She does not believe vaccination. She married to Robert with four children who all not immunized . Now Dr Smith returned home and increasingly worry about HIV and felt quilt to his wife. Dr Smith went out with her and has unprotected sex . Dr Smith was traveling alone. Tara is just recovering from measles. she is non smoker and drink alcohol occasionally. During the conference.Helen Smith is 40 year olds lady . he met a doctor from Thailand who is very lost and lonely. She is using condom for contraception. After the meeting. she is healthy Robert has very difficult school when he was labeled dyslexic. You are about to dress her leg. cutting to her right leg. Three months ago . when Lisa told him about 11 weeks pregnant . She believes all children should develop their own immunity naturally . She has been with Robert for five years with no children.. She comes to see you as a Gp for advise her pregnancy . he went to a Multi-disciplinary international conference In Vienna . otherwise . she played baseball three hours ago and missed a catch the ball landing on a dirty sharp metal . she married to Robert who is a labour. Task: Interview him and advise him appropriated Case 6 Mr Smith is age 47 year old an accountant who is also an active member at his local . He felt sick inside and see you as a GP for HIV test. he was very upset and said ― No kid of mine is going through what I went through‖ He decided Lisa should have a termination Task Interview this lady and manage her appropriate Case 5 Dr Martin Smith is a hospital physician in a large local Hospital.

Smith found Matthew shows no interest in girls and has several male friends. he has taken a hard line on homosexuality. 4) Give your Differential. 5) Management plan Case 3 Andrew McDonald is 60 year old man who has a cardiac arrest while the ambulance is rolling into the emergency. In the next eight minutes run code blue and manage him. He has a good relationship with his son Matthew. Mr. 5) Management plan Case 2 Sandra Anderson is 81 year old woman who was brought to emergency by ambulance semiconscious. Mr Smith was so upset and has not yet talked with his wife. He lives in Sydney with two children.church . Task: 1) Take the relevant history. Task: 1) Take the relevant history. He is quickly brought into the resuscitation room. . He is a bank manager and work very hard every day. Now he is seeking your advise Task Interview Mr Smith and advise him appropriate Wednesday Clinical tutorial by Dr Matthew CAI 13/08/2008 Case1 Eric O'Malley is a 51 year old man who came to emergency because of chest pain and palpitation. 4) Give your Differential. 18 year old university student. In his capacity. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. hypotensive and bradycardia. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. Mr Smith accidently found Matthew was kissing his male friend in his bedroom. which he believes is a sinful perversion .

Task: 1) Take the relevant history.Task: 1) manage this patient according . 4) Give your Differential. please interview him Task: 1) Take the relevant history. 5) Management plan Case 5 A lady 44years age came to your G P surgery with complain of fatigue for three months . 4) Give your Differential. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. Case 4 Tim Brown is a 39 year old male who came to emergency because of sharp chest pain. He feels unwell and trouble breathing Task: 1) Take the relevant history. you can also do the following tasks 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. she devoice her husband one year ago. he presented to you with a problem of polyuria. She also had poor appetite and only eat once a day . . she lost 5 kg in past six months due to poor dietary as patient stated . 5) Management plan Case 6 John Smith is a 54 year old brick layer . 2) Ask the examination finding from examiner only given what you ask 3) Tell the examiner what investigations you want to do. and felt very depressed since. 4) Give your Differential.

She wants the repeated scripts and general advise . Take relevant History from the patient 2. 5) Management plan Wednesday Clinical tutorial by Dr Matthew CAI 06/08/2008 Clinical Examination recall Brisbane 26 July 2008 Station 1 Case: Confusion. Advise appropriate investigations 4. Ask the examination findings from the examiner 3.4) Give your Differential. What medications would be safe and effective for her to use? Station 2 24 year old woman comes with retention of urine and pain in vulva. agitation. You are her GP. Talk to her about your management plan . The consent regarding giving the information about her father is obtained. and delusions. Task: listen to the daughter. Agitation. Advise appropriate investigations 4. 5 She wants to breast-feed her infant. A diagnosis of bipolar disorder had been made 2 years earlier. Her father 65 years old has been diagnosed with Alzheimer type of dementia by neurologist recently. She was previous healthy. Ask the examination findings from the examiner 3. Take relevant History from the patient 2. explain the condition. Talk to her about your management plan . Task: 1. which was treated with lithium and citalopram. Station 3 A 45 year old lady comes to your GP clinic to discuss about the condition of her father. discuss treatment and management options and answer her questions Station 4 25 year old lady has been diagnosed with epilepsy and prescribed with Carbamasepine. and Delusions A 35-year-old woman was admitted to the psychiatry service 5 days after the birth of her first child because of confusion. and she wants a work certificate Task: 1.

equipments provided for your performance . and is experiencing some chest pain and SOB. Take relevant History from the patient 2. Today the patient is back for review. Relevant history taking.Task: Take a brief history then explain the condition and counselling the patient Station 5 A 57 year old lady . Advise appropriate investigations 4. This patient looks very anxious and very keen to do more tests for a definite diagnosis. You are the RMO in a busy ED . your registrar is asking to do Ankle Brachial Pressure Index in five minutes and explain him the findings Station 2. making it impossible to perform activities of daily living independently . 5. A 75 years old man presented with right big toe ulceration 2 months after suffering a fall that injury his big toe . Annette Kohler. Tasks: 1. A 45 year old female patient presented to your GP practice with mild abdominal pain last week and you ordered an abdominal ultrasound. Ask the examination findings from the examiner 3. Later. Talk to her about your management plan . Advise appropriate investigations 4. ask physical examination findings from the examiner . Talk to her about your management plan . presented to you in ED. The patient is looking unwell. write down your medications in the provided medications sheet Wednesday Clinical tutorial by Dr Matthew CAI 30/07/2008 Station1 This is a practical station . U/S was shown on the door. he developed progressive symptoms of right lower limb claudication. but she is stable. Take relevant History from the patient 2. Task: Explain the result to the patient. Ask the examination findings from the examiner 3. Station 6 You are RMO in ED to see this 65 year old man with acute chest pain please see this patient Tasks: 1.

T38. Task: Take history from the wife Tell your DDx to the wife and how you are going to manage the patient. Task: take relevant history from the father Get PE findings from examiner Advice your Dx Mx the case Station 5 A 72 years old gentleman had a knee replacement operation two days ago and he recovered well. You are the father of Peter Smith. She is very active and wants to clarify some questions. Anne Smith is 4 month old baby brought in by father to the ED with shortness of breath. Examination findings: The pt confused. Task: Take relevant history from the father and Give advice Dx Management. The nurse informed the registrar on call and was told to give the patient Olanzepine. The baby had a cold earlier. Task: . Station 3. Today the patient became agitated and confused.2 C and bibasal lung crackles. 6 year old boy who comes to see you in General Practice because the school teacher concerning that your son is over-active and not listening to her advice and instructions (disruptive behavior). Station 6 A 41 week primigravida come to your general practice concerning about her pregnancy.Probable diagnosis Manage the case (order relevant investigations if needed). and cough for 2-3 days. You are an intern and were asked to review the patient. Station 4.

Her mother has rheumatoid arthritis. You prescribe ibuprofen and run some blood tests for ESR. and on the basis of this cough was declared unfit for work by his doctor in January. 1988. A claim for workers compensation was lodged. a violinist in orchestra. She is previous healthy and seeing another GP. ANA and RF Antibodies. she is now want you to be her GP because she just moved to your area. and that of his co-workers in the tea room and at shift breaks. The results shows that she has early rheumatoid arthritis. complaints of pain. Mandy. Today she comes to you (a GP) for the result. has got a skin lesion for which she took a picture. Counsel the patient and answer her questions. . Now he is coming to your GP room for further investigations. You suspect that she may have rheumatoid arthritis. was a bus driver employed by the Melbourne Transit Authority. a type of lung cancer that has an above average strength of association with smoking—both active and passive. 65 year old. He was diagnosed with small cell carcinoma of the lung. Station 7 A 40 years old lady. Station 8 A 25 years old lady who is 10 weeks pregnant (G3P2) comes to your general practice She stated that her niece. Towards the end of 1987 Mr Smith developed a severe cough that was aggravated by diesel bus fumes. Wednesday Clinical tutorial by Dr Matthew CAI 23/07/2008 Station 1: This is a practical station of Spirometry: John Smith. She‘s worried and comes for advice. Task: Advice the diagnosis and manage the case. She said that she has pain in the wrist as also. Get relevant PE findings from examiner Management plan and answer her questions. Task: Explain the diagnosis to the patient.Take relevant history. Over his 35 years of employment he had been exposed to his passengers‘ tobacco smoke. swelling and stiffness in both hands recently.

She had mucosal pigmentation on her lips. Your colleague has seen this patient and PE showed a goitre in the neck Other PE was unremarkable. 2 Examination and investigations. There was no SOB. Station 3 A 22 year student presents with poor sleeping. 3. do a cardiovascular examination. He was worried about the exam. his father passed away unexpectedly due to heart attack. 2 explained the results given by a examiner Station 2 A 21 year old student has a heart murmur coming and going. There was no family history of heart diseases. He ordered ultrasound which showed multinodular goitre of thyroid. . Her mother brought this girl to see you for management Task: 1 Please take a history. 3 Make a management plan Station 4 A 6 year old Chinese girl presented with intermittent peri-umbilical abdominal pain associated with non-bilious emesis for 4 days.Tasks: 1 performs a spirometry on this 65 year old man. He has no cardiac symptoms. A 20 year old man presented with swelling in the neck. 2 Counsel this patient. Tasks: 1. Recently. Present what you have found to your examiner. 3 Make a management plan Station 5 . Present your diagnosis to your examiner and answer examiner. It was end of year exam in university. 2. Task: 1 Please take a history. he comes to your GP for diagnosis.

treatment and complications of treatment. Patient was taking antihypertensives (hydrochlorothiazide). she has been smoking for 50 years and was a waitress. further management Case 2 In the stem a description of a toe with gout was given. 2 Examination and investigations. 3 Make a management plan Clinical tutorial groups Wednesday 09/07/ 2008: By Dr Bryony Van Santen Case 1 Young man came for results of US scan.4-1. TSH 0. But she moved to your area recently and would like you to take care of her Task: 1 Please take a history.6 (0. The scan was given (one slice . Task: talk to the patient. Station 6 A 74 year old lady presented with left lower leg pain. The doctor was unsure what the problm was. She was previously seen by other GP. Task was to tell the patient the diagnosis and to explain about the disease and tell further management Case 3 In the stem was a story of a woman who went to the doctor for something she thought was insignificant. and had a CT scan done.TFT showed FT4 10 (10-24). but "gout" was not named. she felt difficult to do shopping. Task: 1 take a focal history No further physical examination is required 2 Explain to this patient about the diagnosis. Now this patient return for blood tests result and your colleague is in holiday.5). in the stem it was stated that the scan results showed a lump most probably malignant. you are about to see the patient. She complained that left leg pain for three months.

Take a history. ask examination findings from examiner. Case 9 55 year old woman. Briefly discuss anagement to the patient. state which investigations you would like and manage the case. 10 days postpartum. on exam (given when asked for) murmers heard. Take a focused history.cardiac examination. Case 7 . came to see the doctor because she had started bleeding again after het delivery. fatigued with pain in het body for 2 weeks.of liver with multiple hyperdense spots in it). This was a physical exam station. Case 6 . Task do the cardiac exam. tell which investigtions you would do (the results will not be available now) and tel your diagnosis. Case 5 . Task do a physical exam and give a running commentary to the examine. Patient was a real patient. in their early 20's. Parents are uni students. Case 8 . Task talk to the patient Case 4 Stem stated a G2P1. Role player was there as girls mother. A woman with 2 valve replacements and a pacemaker. Manage the case. Ask results of investigations from examiner and explain these to the patient. Task Take a focused history. patient said she had had dental work done (a few seconds before the bell rang) Case 10 The patient was an old role player. I was given spirometry findings consistent with asthma.3 month old baby crying for 2 days. Take a focused history. This was a physical exam station with a healthy role player. who worked as a baker. ask examination findings from the examiner. ask exam findings from the examiner and manage. has 2 bruises on it's face. you do not need to exam the abdomen or the legs.respiratry examination. ask .12 year old girl presented with heavy period.

The "mother" was there. ask examination findings.examination findings from examiner. She had just been to see a gastroenterologist and he told her she had IBS. patient was known with psycosis. tell which investigtions you would like to do. if there were other methods of dealing with ectopic. Clinical tutorial groups Wednesday 09/07/ 2008: By Dr Matthew Cai . give differential diagnosis and manage the case. Then asked what you would do if the abulance was 2 hours away and the police unavailable. The patiet comes to you angry as the other doctor hadn't explained what the problem was and told her it was in her head. Typical story of BPH by the patient. On asking the child had a fever. didn't want to use the leg and wasn't as mobile as before. She said she didn't have to stay if she didn't want to. why she had an ectopic. She said the same thing over and over for 5 minutes. Case 13 Long stem with a young woman who had been to see many doctors and noone had told her what the problem was. She had absolutly no insight in her problem. you had no right to keep her etc etc. with one sentence in bold letters "patient is psycotic and hallucinating". She had had a salpingectomy and wanted some information about what would happen in further pregnancies. why her tube was taken. On exam the child looked unwell and in pain. Take a focused history. Then a bell rang and the examiner asked what you would do and how you would go about it. The "patient" had cut her wrist in an "accident". Task is to talk to the patient and explain about the link between mind and body. investiations and manage. Then asked how long a schedule is valid for. if she could get pregnant again. She was continuously talking and saying she needed to go home and needed sleeping tablets. very long stem. She had had abdominal pain for years and no diagnosis. Examiner was very nice and asked leading questions and helped a bit along the way Case 11 . Case of septic arthritis Case12 GP setting.Leg pain in a 12 month old baby.Patient coming for information after she had had an ectopic pregnancy. She would not let you speak. Management is not necessary Case 15 . if she had a higher risk of ectopic.

. swelling in the right big toe on the first metatarsophalangeal join. He has been in good health except for a high fever that developed two days ago to about 39. Tasks: Please explain treatment option. He complains of pain in his right leg and he has been having an increasingly difficult time walking over the last 2 days. now she complained the left wrist pain. His mother denies reports of recent weight loss.Station 1 Case 2 You are the resident in ED and asked to see a 42 year old man with severe abdomen pain . You are asked to counsel. This went on for what seemed like 5 minutes. Station 5 45 years old taxi driver comes to your GP set up with complaining of pain redness. Just prior to the seizure. He was vomiting once. consent patient if needed Station 4 A 10 year old male presents with decreased appetite and intermittent tactile fever for the last five days. About 20 minutes ago the mother noticed he was shaking of the arms and legs and his eyes had a blank stare. His general health has been fine otherwise. He was unwell for last 2 days with ear infection. This is the second time he is having such an attack. he has long history of hepatitis B and drink 5 bears a day. He has no previous medical problems. Station 3 A 62 year old lady had a fall two days ago. He has no tongue bite. He is moderately obese and non-smoker but drinks about 4-5 standard beer per day. He has a history of falling seven days ago.9 degrees. There was no rashes . or dysuria. he was playing with some toys. and tell about the diagnosis and investigations results (repeat from Adelaide) Station 2 Case details A 24 month old boy was BIBA to the emergency department with a seizure associated with fever. He was not responding to mother when this happen. His mother gave him a small dose of Panadol but no other medications. he is non operatable . you confirmed a HCC occupied whole liver after a CT scan biopsy. He has been on anti hypertensive therapy (diuretic) for the last few years. cough. He has been ill with a slight cough and mild nasal congestion.

Take history from the patient. sometime wake up in the middle of night and crying. lives with his wife and two children Task: Please exam this man‘s shoulders . Ask examination and investigation result from the examiner. He lives with parents in inner suburbs of Sydney. 14. 2. one older sister aged 23 and two younger brothers aged 17. He is taking panacetamol with poor effect. and coughing.Task: Ask for relevant history from the patient and ask investigation from examiner. 3. which is often associated with chest tightness. Give your D/D and diagnosis. he complained that the pain was persistent but not travels down to his right thumb and index finger. He feels down all time. He is a non smoker. explaining your management plan Station 3 Shoulder examination 36-year-old man with right shoulder pain for 6 months months. Task: 1 Take further history 2 Managing and counselling this Station 2 A 65-year-old man presents to the emergency department complaining of difficulty breathing. You are the RMO in ED and about to see him Tasks : 1. wheezing. explain your diagnosis and further management to the patient. He describes worsening dyspnea on exertion. Station 6 A 65 year old patient with known comes with left iliac fossa pain and discomfort. Task: Take further history and answer patient‘s questions. Clinical tutorial groups Wednesday 02/07/ 2008: By Dr Matthew Cai Station 1 A 21 year old male university student who is studying engineering full time presented to your GP clinical for depression counselling.

Ask examination and investigation result from the examiner. before she could get up and help him. who has accompanied him to the ED. explaining your management plan Station 4 There is a 50 ys old lady who is planning to go to Europe in a month‘ time. Tasks : 1. he regained consciousness. he fell out of his chair and hit his head on the floor. Give your D/D and diagnosis. Give your D/D and diagnosis. and intermittent low grade fever. cough. 3. explaining your management plan Station 6 CT scan films reading . 2 years ago she was found to have a murmur. witnessed the event. Ask examination and investigation result from the examiner. There are some real CT scan to be reported by you . nasal congestion. She states that they had been talking in the kitchen when her husband complained of feeling dizzy. management Satation 5 A 7 year old previously healthy female presents to her primary care physician with a 12 day history of persistent thick nasal discharge. 2. She is here for preliminary assessment. His wife. Clinical tutorial groups Wednesday 24/06/ 2008: By Dr Matthew Cai Station 1 A 32-year-old man of Thai descent presents to the emergency department (ED) after experiencing a syncopal event at home one hours ago. After some time lying on the floor. Take history from the patient. give your diagnosis 3. You are the GP and about to see her Task: 1. 2. He then became nauseous and slumped over onto the table.Tasks : 1. She did not follow up on that. His wife did not notice any seizurelike activity (including . 3. examine the patient 2. Take history from the patient.

Fully immunised. No need to take history. previously well. you nee to read fast .no jerky body movements. Tasks: • Take further relevant history from the patient • Ask examination findings from the examiner • Tell the patient about your management plan. On PE: The child is well. You find out that she has a transverse lie. PE • Manage the case 5 . but he has never sought medical evaluation for them. 2. A 2 year old child with cough of 4 days and now worse at night. There is a 6-week old sibling at home apart from his parents. A young female came to your GP to ask for antidepressants again. Lives 80km from the hospital. Take history from the patient. he was immediately fully awake. the patient has no specific complaints other than a bruise on his forehead and mild embarrassment Tasks : 1. 3. When he regained consciousness. explaining your management plan This station is to train you to read a huge written history of the case. At the time of presentation. or incontinence) in her husband when he was unconscious. Ask examination and investigation result from the examiner. alert. When you checked the throat and touched the palate. then testing your skill on Syncopy 2. Give your D/D and diagnosis. alert. and afebrile. not in any form of distress. Task: • History. Your next patient is a 26/40prim. tongue biting. there was no period of confusion or garbled speech. She was previously treated with antidepressants before. Tasks : 1. the child started coughing with an inspiratory stidor. explaining your management plan 3 A multigravid is now in your clinic and is 38 weeks pregnant. The patient reports that he has had several such episodes in the past several years. She has abdominal pain for 3 hours. and conversant. Recent URI in the family. 4. Give your D/D and diagnosis. active. . You are working in a country hospital which is 300 km from the nearest neonatal intensive care unit.

he comes to your GP for diagnosis. There was no family history of heart diseases. including history. 2 explained the results given by a examiner Station 2 A 21 year old student has a heart murmur coming and going. do a cardiovascular examination. . Towards the end of 1987 Mr Smith developed a severe cough that was aggravated by diesel bus fumes. There was no SOB. a type of lung cancer that has an above average strength of association with smoking—both active and passive. He has no cardiac symptoms. He was diagnosed with small cell carcinoma of the lung. Present what you have found to your examiner. Tasks: 1. there is a 60 year old lady brought in by ambulance. 2. investigations and Treatment. Now he is coming to your GP room for further investigations. and on the basis of this cough was declared unfit for work by his doctor in January. and that of his co-workers in the tea room and at shift breaks.Tasks: • History • Management 6 You are the only doctor in a private hospital ED. Wednesday Clinical tutorial by Dr Matthew CAI 23/07/2008 Station 1: This is a practical station of Spirometry: John Smith. 1988. PE. She has no responding to you. Tasks: 1 performs a spirometry on this 65 year old man. A claim for workers compensation was lodged. was a bus driver employed by the Melbourne Transit Authority. 65 year old. Over his 35 years of employment he had been exposed to his passengers' tobacco smoke. Task: Managing this case as much as you can.

3. TSH 0. Your colleague has seen this patient and PE showed a goitre in the neck Other PE was unremarkable.6 (0. Her mother brought this girl to see you for management Task: 1 Please take a history. She had mucosal pigmentation on her lips. Task: 1 Please take a history. Recently.4-1. Station 3 A 22 year student presents with poor sleeping. A 20 year old man presented with swelling in the neck. 2 Examination and investigations. Task: 1 take a focal history No further physical examination is required 2 Explain to this patient about the diagnosis. his father passed away unexpectedly due to heart attack. He ordered ultrasound which showed multinodular goitre of thyroid. He was worried about the exam. It was end of year exam in university. Station 6 . Present your diagnosis to your examiner and answer examiner. TFT showed FT4 10 (10-24). treatment and complications of treatment.5). 2 Counsel this patient. 3 Make a management plan Station 4 A 6 year old Chinese girl presented with intermittent peri-umbilical abdominal pain associated with non-bilious emesis for 4 days. Now this patient return for blood tests result and your colleague is in holiday. you are about to see the patient. 3 Make a management plan Station 5 .

She complained that left leg pain for three months. But she moved to your area recently and would like you to take care of her Task: 1 Please take a history.A 74 year old lady presented with left lower leg pain. 2 Examination and investigations. 3 Make a management plan . she has been smoking for 50 years and was a waitress. she felt difficult to do shopping. She was previously seen by other GP.