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as a GP for diagnosis. He has no cardiac symptoms, no SOB. Everything is normal, no family history of heart problem. General health is fine. Tasks: 1. do a cardiovascular examination. ( please do not cover abdominal examination and lower limbs examination.) 2. present what you have found to your examiner. 3. present your diagnosis to your examiner and answer examiner. My approach: do the physical examination following the textbook. It was a medical student with no murmur at all. Questions from examiner: 1. what other physical examination do you want to do? ( I stopped after I auscultated role player.) valsava examination. 2. if a patient has a murmur coming and going, what do you think? – functional murmur? Question 2: A young student presents with dry cough, mostly in the morning or at night, general health ok, non smoker. Tasks: 1. do a respiratory examination, 2. report your finding to your examiner. 3. answer examiner‘s question. My approach: Again, follow the textbook‘s instruction. It was a medical student with no positive finding. I told the examiner that there w as no positive finding. Then she asked me what was the diagnosis- asthma. Immediately she asked me what else I wanted to do. I said spirometry. She handed over a spirometry result: FEV1 decrease, FVC decrease, after bronchodilator, FEV1 increase but lower than normal, FVC increase but lower than normal. I said it was consistent with the diagnosis with asthma. Question 3: (same question from April Melbourne 2006) A young lady driver has a few car accidents because she can not see the car coming from the intersection. Please do a visual examination. Tell your examiner what is your finding. Make a diagnosis and management plan. Please note that MRI is the gold standard of diagnosis. Question 4: (same question from November, 2005, Melbourne) You are an ED intern, a 45 years old man presented with right upper quadrant abdominal pain for 6 hours, nausea but no vomiting, this is the first attack. On examination: temperature 38.3 C, other vital signs normal. 1. please explain to your patient what is the most likely diagnosis 2. do the essential investigation. 3. management plan Question 5 A young student presents with poor sleeping, examination is coming, he is worried about the exam. Recently, his father passed away unexpectedly due to heart attack. Please take a history, Counsel this patient, Make a management plan My approach: I asked all the questions related to depression anxiety, such as drinking, eating, weight, sex drive, usual interest, the impact of his father‘s death on his life. and also the past psychiatric history, drug and alcohol history, medical history, social history including performance at school, family relationship, employment, Explain to him: the reaction of bereavement. Emotional support, Management: sleeping pill, medical certificate, psychologist counselling. Question: how should I use sleeping pill, what is the prevention of heart problem.
Question 6: A 2 year old girl presented with headache, fever for 2 days, father is concerned, he brought his daughter to your GP setting, Her father has family history of migraine. Please ask for examination finding from examiner. ( no further history taking) Manage this case. My approach: ask for general appearance. Vital sign, ENT, any rash? Neck stiffness, kernig sign? Other system. – only phalangitis, and bulging ear drum. Sign of dehydration, not drinking well _ from father, but examiner said baby looked well? My management plan: Explain to father that it may be viral infection however I can not exclude meningitis or other serious infection, so please observe and send to ED if rash, fever increase, drowsy, not drinking well or eating well. Question 7 24 years old lady presents with vaginal bleeding 2 hours after 8 weeks amenorrhoea. General health ok. She is obese. You are a GP. Please take a history Ask for physical examination. ( investigation not available) Discuss with examiner about your management plan. My approach: she is not planning for family, partner is using condom, she is not on pill, bleeding more than usual. LMP 8 weeks ago. Regular period, no pain, no STD history. No family history of bleeding tendency. Not on any regular medication. PAP smear 6 months ago, normal result. No pregnancy history. No abortion history. Now she has no abdominal pain. Only per vaginal bleeding. Has stopped now. Physical examination: haemodynamically stable. No tenderness or mass in pelvic, speculum: os close, no bleeding, no polyps or ulcer. Examiner asked: what is your diagnosis if beta HCG positive? Threaten miscarriage. What other investigation do you want? – U/S What if beta HCG negative? Polycystic ovarian disease. Or other bleeding tendency, or problems in the uterus such as PID…. Question 8 61 years old bricklayer(male) presents with two years history of back pain and thigh pain? (not remember bilateral or which side) Past history: osteoporosis Your task: 1. history taking 2. ask for physical examination finding 3. your provisional diagnosis and management plan my differential diagnosis: 1. sciatica – fracture or disc prolapse – malignancy or osteoporosis 2. osteoarthritis 3. claudication 4. trauma? I asked the history carefully, first, pain question. Then I asked during the last two years, has he been to any doctor? He told me that a doctor told him that he had got spondylosis of spine (x-ray) then I knew it might be osteoarthritis. Then I asked examiner the hand examination and shoulder, neck, back, hip, knee etc… The examiner told me : heberdon nodes on hand.. Then I got a clue…… Management x-ray and referral to rheumatologist… I am not sure I am right or not? AMC MELBOURNE 29/04/06 I never realized how difficult it will be to make a recall after the exam. I do not remember all the tasks and some of the examiners questions. Stems were also much longer. So please be careful when you read these questions and find your own answers!! NEW QUESTIONS
. 3cm dilation. Pt loves his job. Examiner asked about surgery – Lap banding of stomach 4.1. (My answer cellulitis.heartfoundation. Accommodation – couldn‘t see a thing but said normal Pupils reflexes –examiner said normal. can‘t see the signs when driving car signs on the left and right bumping into things and p eople. CVA again.normal. comes to your GP practice TASK.com. Rash has been there for 3 months. Advised re: Diet . or Syd MAY 2004 but changed) 5.o patient comes to your GP practice for insurance purposes.BMI 34. FVC and ratios. To answer properly I‘d look up for spirometry from http://www. angina. hypothyroidism excluded. saying I can‘t see from LEFT and RIGHT. at work does everything with hands.offered dietician. Rash very itchy. 3 months after he started his work.pt NO ANcare. Visual fields. No further Hx My answer –still talked re:Family (anybody with diabetes. She will ask you about medications. (normal values were provided by examiner) Pt asked one question – Do I have asthma? Other candidates had Normal result of spirometry and reassured the pt 2. not only topical steroids and gloves as protection. You‘ re GP. CVA?. ask examination findings. What other investigation would you do. Reassured-. You‘re GP working inObs Ward of countryside hospital – no obstetrician available.org. What other tests?. Eye movement – Normal Examiner asked Summarise findings – Bitemporal hemianopia. only they can give you high BP. The examiner asked about complications. She was not interested anyway (in contrast to the stem!!!) Loose your weight slowly. My answer: role-player helped me. Exercise (all the info from Pt‘s Edu and http://www. discuss condition with patient. Baby in OTposition. TAKS – discuss with patient. possibly optic chiasm. Examination from the DVD.getting stronger ._spiro. Examiner expected to hear oral steroids as tx . 50 y o patient wants some advice about loosing weight. My answer: contact dermatitis. treat with oral Flucloxacillin after checking BSL and lymph nodes) I‘d read at least from Murtagh and Pt‘s education re: this topic 3.o. My answer: I asked how long in labour – Pt said 3 hrs. Station 0. Look up Talley. which he liked. in a sensible way. very good and important that you came. Spoke re:cardiovascular risk factors Explained the risk of increased weight –heart. good decision. (looks like old question – Myopia –Mel NOV 2004).au) And spoke about osteoporosis if she does not exercise No smoking and.take Hx. safe levels of alcohol Re medications :said don‘t know much about.….bitemporal hemianopia Fundoscopy-examiner said normal.I said CT and P.-Theory-from the book. esp DM ( sweet drink at 28 weeks) – pt all OK Contractions? – examiner said every 3-4 min. FVC interpretation.tell Dx. Examination Snellen chart. Brother has psoriasis (to confuse you).nationalasthma. TASK – Examine eyes. pain. no gloves.18 y. red).asp Video is there FEV1. Photo dorsum of hand. 41 weeks (can‘t remember possibly primi ) in labour. but in this exam the man is 50 y. (Not from AMC book –scaly lesions on whole dorsal surface of hand. Discuss results with the patient.. (Similar to Syd SEPT 2005. BP. full neuro examination and baseline bloods.she said no). Cushing. A lot of Interactions with the examiner at this station which makes it harder. He had asthma when he was 11.. TASK. TASK Do spirometry.Pt is a brick layer started new job 6 months ago. I told the role-player he does not have to change the job. What‘s the cause – brain tu.au/html/ma.invaluable for any examination (only hip& back not there) 5. cervix effaced . 50y o man problems with vision. Passed meconium. are you comfortable – dehydration. discuss situation wih pt. DM.Take Hx from patient. calculate FEV1. holidays made it better.
no dry skin/cold intolerance. maybe due to diet. IDA from P. Still confusing this question.continue same Pill (as 2 months no period. asses cervix.We have to exclude pregnancy now and wait for period to come back. women came 3 days ago-previously on Prozac stopped 3 days ago.what will you write in chart? Iv line. discuss condition with pt. ( same as Syd AUG 2003) 8. baby between OT and OA.Obvious IDA I asked for tissue transglutaminase for celiac – Examiner – normal and nothing else available. periods regular before. CVS< RESP>ABDO NAD. augmentation not required.no gyne procedure. I asked for iron studiesExaminer gave me a paper --low Fe. no test necessary now If you concerned we can stop Pill and wait (use barrier protection) or change Pill to higher estrogen or Triphasic.Devitt 7. I explained all due to SE of antidepressant. PE from examiner.canal for baby open. Pt asked ―Will I get pregnant‖. Other option I‘d recommend . no headache/vision probs/nipple discharge. Yes. comes to you as GP. unwell today.Examiner said Manage I said . Green stuff passed but does not mean there‘s a problem (41 weeks).take further history.unavailable My answer : explained – exclude pregnancy first . but usually when 2 antidepr. Go home/ speak to husband/come back with decision in few days. Pt unwell on Prozac before given Zoloft. BP. You really need the tests.but hidden points were Pt is 85kg. TASK.exclude cord prolapse. Explained why loosing iron maybe diet. Result of microcytic anemia attached NO further Hx to be taken. may improve your symptoms. low Fe saturation. 8.Did you have sex over last 2 months. Similar case in Greer – Problem based Obs&Gyne. started on Zoloft. Examiner also wanted to hear . PE – P-normal. 2 months not significant. The case was really ―dealing with difficult Pt/convince her to have the test‖. The woman did not want any tests. OLD QUESTIONS/PAST RECALL PAPERS INCOMPLETE and CONFUSING 6.Examiner not available. if sthn else/sthn nasty better to know early. -Put CTG (examiner said– reactive) and LEAVE IT ON.Can it be sth else??-Not likely we need to find the cause. PE – Examiner all Normal Pregnancy test.suction airways of baby. mixed from dif ferent groups.30 yo woman on OCP no period for 2 months. jittery. not dehydrated. So my Dx is SE of antidepressant. T.maybe sth more serious. NO Ix result available TASK further Hx.countryside. see if period back and loose weight over next 2 yrs. maybe ulcer.You‘re intern ED. Talk to pt. I have to ask you sensitive qq. we have to find the cause. TASK ask examiner examination findings. there‘s sthn we call serotonin synd.no reason to worry). examiner – cervix 10cm now. P. low ferritin.maybe other cause. Ix not available. high transferrin. no meds only Pill. If losing iron due to ulcer it‘s e asily treated. Examiner. Discuss condition with pt (same as Syd MARCH 2005 Retest) 6. if negative don‘t worry. no acne/funny hair on face/Fhx of PCOS. Colonoscopy/gastroscopy invasive but done under sedation so you will comfortable. Can you give me Iron? – OK. dizzy. BP no postural drop. no pain. -Fetal scalp electrode. moving down. Metoclopramide. now 85 kg. 50 y o women postmenopausal come to your GP practice for the results. Check pt GA. I explained IDA. Pt asked. does not . Did not take any other meds. these 2 are SSRI‘s . You‘re overweight pregnancy MAY be complicated by high BP and DM. baby turning into good position. HX – on Microgynon 30(forgotten to ask for how long!). discuss condition with Pt. presenting part. in taking Hx I repeated what was in stem. did not loose/put on weight recently. you can‘t tell thick or thin -I want to re-examine pt. brisk reflexes Urine no ketones. (same as Adel SEPT 2004. but still need to find the cause. I‘ll keep an eye. Nsaline. Today she‘s vomiting.smoke.hydration.station +1 talk to pt Talking was reassurance. See me in 2-3 weeks. -Asked re:meconium Examiner green .call another DR in Hospital for 2nd opinion. wants to be pregnant in 2 yrs) 7. .
you can go with the child in ambulance. IUGR from Greer. Operation possibly within 2 weeks re. call Registrar in Hospital.Pt asked I can‘t sleep. (Similar to Syd May 2004) 9. I answered I‘ll ask senior (did not know if I could give Valium) 9. for appointment as early as possible. ask PE and Ix. Pt asked any SE of anesthetics. T-40.lump in groin. Put on weight since was born. Pt asked Am I doing sth wrong?Continue breastfeeding as breast milk better for baby and not the cause of this problem. no smoking. no neck stiffness. breathing etc USS . very common. baby kicking less (I forgot to ask how many kicks/day now!!!) PE – P. Baby hungry 1 hr after feeding (other candidates got 2-3 hrs) then settles. In Hx no headache. Father of 5 months old boy comes to your GP practice re: lumps in Rt groin and another one around belly button. You' re wife pregnant? Pt -No. OK. Good diet. (same as Mel FEB 2006 !!) 10. Started explaining and bell rang. Still send you for USS to exclude pyloric stenosis if result OK baby has reflux. My answer: good you came. Funny other candidates got Small for Dates from Ix. you child has 2 hernias-weakening of muscles in tummy. Normally the one around belly-button can wait until 2/4 years If baby crying upset. no hx of infection. Hx -Baby vomiting not on further questioning not so much. You‘re GP. blurred vision. discuss mx with mother (same as Adel OCT 2005) 12. Photo from AMC book. today drowsy. development OK. Child happy.baby 10th percentile asymmetric What's your Dx? .go to ED ASAP. Boy had sore throat last 2 days. Pt asked. Very good you came. petechial rash. Any allergies to penicillin? Pt . PE. elevate the bed 20degrees. manage the case.can it be sth else? Not likely as child really sick needs to go to ED now. says baby vomiting everything after feeding. to others examiner said.IUGR Talk to Pt. My answer: it's urgent. call Ambos. no lump in tummy. only a bit on the clothes. give benzylpenicillin 600mg iv. Mother 4 weeks baby comes to your GP practice. TASK take further Hx. but benefit outweighs risk. 12. Vomit only milk – no blood or green stuff. Blood poisoning. I also need to notify DHS.channel did not close.CTG (examiner says reactive). TASK explain diagnosis and manage the case (same as Mel NOV 2005) 11. Your patient was 29cm at 30 weeks. put on weight. very important. BP low. more frequent . urine dipstick no protein I asked for Ix . very dangerous if not treated. so you'll both need meds for prevention 2 tabs. take blood for culture. Can last up to 9 months. gets better with time. hope the child will be fine. Lumps come and go.(examiner. TASK . She wants to change to bottle feeding. reflux/draw a picture/. Doppler (examiner-what you're looking at? .S/D ratio.about lump around belly button surgeon will decide if he will repairs both together. check tummy if lump-hard .examiner says. no iv drugs. she props baby up after feeding . This question still confusing. can be dangerous if bowel gets stuck outside. PE – normal. and give smaller. Did not feel any lump. daily for 2 days. now 4 weeks later she‘s 30 weeks. which artery ?. 2 y o boy brought by father to your GP practice 50km from Hospital.which parameters you're looking at ?) tone. ANCare normal –USS 18 weeks. tummy pain. explained about testis traveling from tummy to scrotum. Think if anyone kissed. so I'll explain very briefly. Guidelines RCH 11.explain condition to father.NO I do iv line. keep baby prone 30-60min. OLD QUESTIONS REPEATED 10. sweet drink 28 weeks.? Every medication has SE. dehydrated. I explained gastro-esoph.same bug as the one causing meningitis. shared food with child over last 10 days. P-high. You can thicken feeds with Carobel/Gaviscon.umbilical) BPP .BP normal Heart sound 140/min.NO Ix available. discuss results with Pt. Figures may have been different but still decreased growth around 28/34 weeks TASK-take further Hx. I am calling surgeon now.
answer questions. Apprehension test. Explained re:vessels closing and opening. KUB and helical CT. but takes a lot of your energy so you‘ll have to think and decide. Renal colic from P. ask Ix. the stress may be gone. sleep. Pt asked . Still referred her to PANDA Pt asked – should I breasfeed? Up to you . energy down. comes to our GP practice for advice.what‘s mx. (better answer was ―not sure as he has not passed the stone last 2 months‖) Where do you refer? To surgeon.breast milk good for baby. (same Syd MARCH 2004) 15.. TASK. Chinese food. has another baby 30months. 1st episode 2 months ago. mood low. comes for check up. (I forgot risk assessment!) Dx explained Postnatal depression/we don‘t know why it happens.complications of Reflux? – Bell rang GORD – from Pt‘s Education 13.pain happens when stone moving. TASK take further hx. very severe.sediment in urine. stone builds up around pain. had CT scan done excluded brain tu). Explain the pt . try to find time for yourself. 16. Senanyake. discuss further mx (same as Syd AUG 2004) 13. Pt does not want to see counselor. Young man comes to ED 2nd episode of severe pain in the back.feeds.Which nerve? Axillary Which muscle for abduction? Deltoid Pt asked can I play? Yes but no dunking Examiner asked where you refer? Sport medicine Clinic What do you do for recurrent ? Bell rang. went away now. Common . psychiatrist. see old friends. Answered borderline. appetite.Common Cases./maybe hormone changes. Young women gave birth to child 4 weeks ago. or lithotripsy. what you‘ve got is migraine. Take relevant history Explain the condition to the patient Management . pt moving around to make it better No change in urine color. Devitt. Pain occurred suddenly.40 yo woman (2 episodes of headaches with nausea. interest gone. tired (can‘t remember what else) You‘re GP TASK talk to mother. usually multiple factors.examine shoulder give running commentary. No hallucinations. pain radiating to groin. impingement test negative Asked for pin to check patch on the deltoid (examiner says normal) Questions from examiner. no hx of depression in past. Basketball player had anterior dislocation 6 months ago. Pt‘s Education 15.as you have no cancer. everything normal.explain migraine. Management – Aspirin(asked if no pain I tummy)/ Metoclopramide if not better Ergotamine (asked her no probs with heart or BP) Prophylaxis not required as yet. discuss Dx with pt (same Syd MARCH 2006!!) 14. TASK. red wine etc. Post Natal Depression The 28 years old woman came to your GP practice after delay 4 days from appointment. Different causes. I‘ll take blood tests and ask consultant. (some candidates got 10kg weight loss). relaxation. Dr Gya. dos not think baby has special power. She just gave birth to baby 6 weeks ago has another 10 years old child at home. Migraine from Murtagh 14. husband supportive. Dr Gya showed CT with stone. Can he go home? Consultant will decide. Come back in few days if not better maybe start antidepressant RECALL 29th APRIL 2006 MELBOURNE 1.Shoulder examination GP setting. She complains doesn‘t have enough energy and can‘t organize herself. so write a diary. Pt was teacher a lot of stress in life. discuss condition(same as Syd JULY 2004) Pt tired no time for herself. My answer: Good news. Examined the shoulder as from DVD .happens to 1/7 women after birth Come back with husband. Stone is 5mm. maybe pt goes home and wees thru mesh. Ix asked for dipstick. photophobia. Recently unwell.
O/E GA: looks ill. TFT. cheese. Septicemia Father of 4 years old child came to your surgery because his child looks very ill. Take relevant history Management 4. fever and developed rash (as picture in AMCQ book page 118). Ask relevant history Explain the condition to the patient Management 3.…. caffeine. CT brain. Take relevant history (no more than 2 minutes) Explain the condition to the patient Management I congratulated the patient and explained to the patient about enlargement of blood vessel on the scalp and tried drawing the picture as well. visual field and funduscopy.2. VS: BP 100/60 Temp : 40 degree RR: 98 Explain the condition to the patient Management You know the song guys. The pain radiates to his right groin and testicle. You as a GP can give her she said.Order the necessary investigation. The CT brain result doesn‘t suggest any tumor. abdominal X-ray. notify health department. I said to the examiner that he has bitemporal hemianopsia probably due to compression of optic chiasm. I explained to the patient about stone in his urine passage. Bitemporal hemianopsia The man 48 years old came to your surgery. He complained of having visual disturbances. 24 hour serum cortisol level. prolactin level. Examiner asked: • What if she doesn‘t get better? I‘ll refer to neurologist and they might give her sumatriptan or ergotamine. Examiner asked: • What else the investigation you need to order? CT KUB • What stones do you think it is? Calcium. The doctor gave her Sertraline. Management of migraine The woman 38 years old came to your surgery with severe headache and vomiting. • What else? (Examiner stopped him and said okay you finished earlier you can wait outside. 6. 5. Examine the patient eyes Order necessary investigation I checked for the visual acuity. Explain the condition to the patient . Two days ago he had accident because he didn‘t see a truck coming from the side of the road. He had similar pain 2 months back. MSU culture and microscopy. 7. explaining condition to the patient. • What from the blood you want to look? (Examiner pointed the stones so I understand what he wants) Serum Calcium and Phosphate. Then I gave her an advice about lifestyle modification reduce wine. vomiting. blood sugar. U&E. • What else? I wasn‘t sure about this station because examiner kept asking what else? Then the bell rang.That real patient had visual lost on the lateral side. prophylaxis for household contact. Role player asked : • Why do you think I‘ve got this condition? Because there‘s possibility that you didn‘t drink enough water. Phosphate and Uric acid. She‘s been on fluovoxetine for 3 years and then she came to ED. Iron Deficiency Anemia Woman 48 years old menopause came to your clinic to get result from her blood test (attached. Management Examiner in this station was very nice. smoking. Side effect of antidepressant Woman came to ED feels nausea. . (Pituitary adenoma) Examiner asked: • What are the sign you looked on the patient? • What investigation you want to order? FBE. She had a history of migraine 2 months ago. suggested iron deficiency anemia). etc and paracetamol and antiemetic tablet. jittery and unwell. lipid profile. I said to examiner I want to order for FBE. Renal stone 28 years old came to your surgery after having severe abdominal pain 2 hours ago.
All normal. doesn‘t have tummy pain and vaginal discharge. I talked about referring him to allergic clinic to have a test done and avoidance to the materials that you allergic to. He had shoulder dislocation on the right and nerve injury. Primigaravida woman 28 years old came in for routine check up. There‘s possibility that they‘ll move you to another department Role player asked: • How long you going to put me on antibiotic? I haven‘t answered and bell rang…. as well as family history o f those conditions. 41 weeks primigaravida came to ED.VS. You have to manage her by yourself. Family history (-). Then explaining about GE reflux and drawing a picture. swab. TFT. He came to your surgery asking you when he can go back playing basketball again. 11. It could be due to stress or side effect of OCP. I explained to him that he had an allergy probably due to cement complicated by bacteria. I gave him prednisolone and antibiotic. If they come back normal we‘ll wait for another 3 months if your period doesn‘t come I‘ll refer you to sp. Go on examine the patient. Hypertension. Now she came to you and her fundal height 30 cm . FBE. I asked examiner for Pregnancy test urine and blood. prolactin level. ObsGyne registrar and consultatnt are not there. Gastrooesophageal reflux. Four weeks before you checked fundal height 26 cm. heart and lung. Ask relevant history Ask examiner about examination finding Manage the patiet 13. The 18 years old student playing in basketball competition. Take relevant history Ask examiner examination finding Management I took further history. She is in labour. O/E cervix dilated 3 cm LOP (in the morning LOT. I examined for sensation on deltoid muscle and powe r (abduction) • What else? The bell rang… I was thinking about radial nerve as well. 10. Examine the shoulder and nerve injury. Presented with hand (the picture attached: swelling with sign of dermatitis and infection between the fingers) Take relevant history Explain the condition to the patient Management From history the patient said it came suddenly. I started examine the shoulder. but if you have any concern come back to see m e. LH. I wasn‘t sure about this case. 9. ENT. I‘ll follow her up in 1 week. I reassured mother that‘s nothing wrong with the baby and the breast milk. He is a builder and recently he worked with cement. Contact dermatitis The 32 years old man came to tour surgery. If the condition doesn‘t get better you can add corn flour to your milk or gaviscon. Mother thinks there‘s something wrong with her milk. usually this condition will clear up by itself when solid is introduced abut 6 months old. Check it again in the book. Ask relevant history Ask examiner examination finding and order necessary investigation Explain to the patient From further history the woman stopped her period suddenly. If there‘s abnormality I‘ll refer you to specialist straight away. I said to the patient I‘m waiting the result of the test I ran. he doesn‘t have any allergy. 12. He already had an operation fixing it up 6 months ago. The mother of 1 month old baby came to your surgery because the baby always vomits after feeding. You are HMO in Obstetric and Gynecology department. So please check the books.8. And role player asked are you sure that‘s my baby‘s okay? Bang! I realized I forgot to do PE. The woman 26 years old came to your surgery complained of stopping her period after two courses of oral contraceptive pill. DM. The baby grows and develops well.. Examiner asked: • What nerve could be injured? Axillary nerve. but not sure. the baby‘s well so far. Examine the patient Advise the patient about returning to the competition The examiner was really old and very nice. abdominal examination. Examiner said good but they are not available. FSH. Then report to your employer regarding his condition. No past history of STD. Then I said to the patient your baby‘s normal. means tranverse) and meconium stained. Huh? Okay. I said sorry to examiner then asked GA. hay fever or asthma.
What type of OCP is suitable for me? .Take history Ask examiner examination finding and order the necessary investigation (Examiner only will give you what you ask) Manage the patient 14. a remote GP. She came to you for advice on weight reduction Advice the patient Answer patient questions regarding medication to lose her weight.Young university female student wants to start taking OCP. otherwise the baby is fine. Umbilical And Groin Hernia A father of 4 months old baby came to you complaining of a lump in his right side of the abdomen as noticed by the father in the bath comes and go. Task: Manage this pt and answer the questions raised by her mum Her mum asked: .How would DM affect my pregnancy? . Do spirometry Explain to the patient the result compare to the expected value I gave up in the middle of this station so definitely I failed this station . Weight reduction Woman 43 years old BMI 33. Read it in the Talley o‘Con nor. Then referring the patient to a surgeon and saying possibility of twisting if it‘s not corrected and should be in two weeks time.What‘s wrong with my daughter? .Young mother comes to see you. Clinical Exam Melbourne Feb 11. need to have operation done and don‘t put anything on it.What are the benefits of circumcision? .What are the complications? . 15. The umbilical hernia.What are the contra-indications? . 16.O/E : There‘s umbilical hernia 1cm.Any side effects associated with OCP? 3.Should I keep taking Insulin? . Felt really bad.What kinds of blood test are you going to order? 2. I had no idea at all. it‘ll reduce by itself when the child gets older but if it doesn‘t whe n the child 5 years old. Spirometry 28 years old man with a history of asthma came to you. He hasn‘t been using ventolin in the past 2 years. both testis are in the scrotum Ask few clarifying questions Manage the condition I explained and drew a picture as usual. Task: Pre pregnancy counselling Pt asked: .What are the effects on my baby? .A primi 38 wks had a convulsion while sitting in the waiting room with her mum to see you. 2006 O&G 1. Task: OCP Counseling Pt asked: .25 yo female patient with more than ten years‘ history of DM type 1.How are you going to deal with my daughter? .Any harmful effects on my daughter or her baby? Paediatrics: 4. Task: Counselling Pt asked: . He has symptom free for 2 years.Would I need a CS? Examiner asked: . enquiring about circumcision. a GP.
abnormal of live function test.What will you give him? . no hx of dark urine. bradycardia.Am I going to get these reactions every time I have walnut butter? .Patient wanted to go home to sleep .Can I go camping? 12.Can my son go to camp with school? . what are you going to do? Psychiatry: 7. Dx. Dx.If it‘s hard to establish iv access.What is your provisional diagnosis.Patient has auditory hallucination . Task: Examine her CVS and report to the examiner your findings. He gets swollen lips and difficulty breathing. Task: Counseling Patient asked: . Dx: Haemochromatosis . Patient asked: .What do you think he has? .A 9 yo child is just diagnosed Diabetic type 1. feels tired.What if he refuses to be admitted? . Task: Counseling. Dx: Aortic Stenosis 10.Does my son need insulin for the rest of his life? . She denies any abnormality. are seeing a young boy who presented with fever and rash (Picture is presented).What else should I not try? .What‘s your dx? Why? (Anorexia Nervosa) .1st episode acute Psychosis: nurse noticed wrist injury.What are the side effects of Haloperidol? Medicine 9.How about him overstaying with his mates on weekends? 6. referred by his GP to see you.A 67 yo lady wakes up in the morning with weak Rt arm and slurred speech that lasted for one hour (TIA case) Task: Examine the relevant system/s 11. and then gets better after taking Ventolin.5.No suicidal ideations .A 60 yo lady has been told by a previous GP that she had a murmur.An asthmatic patient was at a party last night and tried walnut butter for the first time. His father wants to know more about it.45 yo male patient.Would you admit him? . she wants to travel oversees.Young female comes to see you just because her parents asked her to do so.? (Septicaemic Meningitis) .Very agitated and swears all the time . Task: Management and counselling his father Examiner asked: .No insight Task: Focused hx and mx. non alcoholic. Task: Hx.If allergic to penicillin which AB would you give? . and Mx Examiner asked: .Can you give me something to get some sleep? Examiner asked: . Father asked: .What‘s the management to my son? .Would you admit this patient? Why? 8.Is there a way to cure or prevent these reactions? . cardiac problems. lives with 3 friends Note: no more hx required . Mx.You.What‘s your management? . Task Ix. a GP working at remote area.
c) Herpes zoster 4/ A man comes to you since right after eating the nut. So. Dx: Lipoma 14. DD Pneumothorax / pleurisy / PE / Pneumonia / MI 16.65 lady had pain for 3 hrs in the morning and bloody diarrhoea. hypoglycaemia. Task: Management. CTscan is the best since it can prove PE or pneumothorax quickly and accurately.How to do the sling? . You also warn him about anaphylactic shock with serious symptoms and signs. Patient asked: .Can I ride my motor bike? . . she is normal. Q: Will I allergy with other food? A: It‘s very good question but the specialist will discuss with you when you me et him. Your tasks are: • To discuss with him about his problem. Your tasks are: • To do physical examination? • To discuss the DDx and tests that should be done to confirm the diagnosis with the examiner? You do the upper limb examination and talk to the patient for 1 second to prove she does not have any speaking problem. Now.50 yo male patient with a swelling in his scalp Task: examine. The physical sign has not been detected any abnormal sign. The painful area is in the border between the left chest and abdomen.For how long should the patient use the sling? Melbourne 11/02/2006 Medicine 1. The diagnosis is TIA and to differentiate with other causes. he developed throat irritation that was subsided after inhaling antihistamine (I cannot remember the name of medication). You must refer him to the immunologist. nausea.An obese male presents to you with pain in the left lower chest. 3/ A 35 yo man came to you because he has developed the chest pain that only radiated to his left arm and his neck. Your tasks are.Surgery 13./ Heart examination. Dx & advice on management.A middle aged patient fell of his motor bike and fractured his clavicle. Hx of AF and appendicectomy Task Hx. The rest is normal.Can I drive my car then? . DD Mesenteric artery occlusion / ischaemic colitis 15. talk to him about epi-pen. • To take the history? • To take the physical examination and order the tests to have DDx? The symptom is only the pain radiating to the left arm. 2/ A woman came to you because she had slurred speed and upper limb weakness 2 hours ago. heart block.g. DDx are a) Angina or MI → ECG. Task: Hx. troponin enzyme.What are you going to do for him? . as well as another serious problem? • MX? This is a case of nut allergy. the information of nut allergy in the wallet or bracelet to let the ambulance officer knows his nut problem. e. b) PE or pneumothorax→ chest X-ray and CT scan.How can I have a shower? Examiner Asked: .
Morphine. He comes to you with liver enlargement. She only has taken the medication for her heart. Your tasks are: • To do physical examination? • To give DDx? It is a case of lipoma. Then. Your tasks are: • To explain the problem? • To discuss the complication and Management? • To perform the sling? Paediatrics 1/ A 2 yo boy comes to you because of hypotension. and then inject ceftriaxone 50mg/ kg (explain why you do not use penicillin because of the anaphylaxis in some people. it was easy to talk. Talk briefly about the complication. Your tasks to discuss with his father are: • What is the kind of DM in his son? • Mx • Complications? How to avoid? Patient education is a good source. During waiting for the ambulance. to play sport with his teachers‘ notice. hyper/hypoglycaemia. Removing it and studying under microscope will give an accurate answer. Like this case. Do not scare when you see 2 examiners. Q: What else will you do? A: I will inform to the authorities and prescribe rifampicin to his relative. Discuss short and long acting insulin briefly and leave the answer for DM specialist since he will prescribe short or long acting insulin. Your task are • To take the history? • To ask the physical examination and test results from the examiner? • DDx? This case is haemachromatosis→ because he also has a heart problem and serum iron increased?????. The US show fatty liver.g.irregular →gut necrosis. and IM antibiotic are the basic procedures in the country-side clinic. and rash that is illustrated in the picture. Her abdomen is totally distended and rigid. He does not drink. Your tasks are: • To take the history? • To ask the physical examination. He can go out to camp. Her pulse is irregular. Mx: 1.5/ A man has migrated to a new area. You must explain to the patient that the lump is not likely to be a cancer lesion because he has had for 2 years and you cannot find out any lymph nodes in his neck and head. A boy who develops DM has been discharged. He has no neck stiffness. you will call ambulance immediately. Explain to his parent about the disease. 3. . fluid and other resuscitation. Surgery 1/A woman comes to the hospital because of a serious abdominal pain. It will be confirmed by CTscan and barium enema without preparation. if the boy‘s vein collapses. cold temperature. Call surgeon to admit to theatre (critical error if you do not know). 3/ Clavicular broken bone with X-ray film that is very clear cut. and smoking.I was not very good for this case. 2/ A man has had a lump in his head for 2 years. Refer to specialist. She did not take aspirin or NSAIDs or other medication that can cause gastric bleeding.) Q: During waiting the ambulance. 2. Blood tests and others for preparing surgery. You must say his son‘s life will be normal if the son follows the advice from the specialist. you draw out his blood into the tube. the dietician and physiotherapist (very important to keep BMI in the normal range). what will you do? A: Fluid transfusion into the tibia. Q: What is the S/E of rifampicin? 2/ A new case with 2 examiners. e. Your tasks are: • To explain to his father what has happened to him? • Mx? This is a case of septicaemia. Her faeces is brown colour. the test results from the examiner? • Mx? The woman has 9/10 abdominal pain.
You must know the rule in this case that is the pregnant woman must be treated as a case of eclampsia until you can prove other causes. Her BMI is 15 and the signs of dehydration. She has just married. Now she is conscious. she tried to cover her body. Q: Which kind of pills you will prescribe for me? A: I will prescribe the lowest dose of pill for you. Your tasks are • To take the history? • To report the psychiatric problems to the examiner? • To diagnose and manage the case? This is a case of anorexia nervosa in the young girl who eats 3 meals/day with only vegetable. esp. Q: Can you choose the pills that are suitable for me? A: I cannot. The examiner says every thing was not available yet. Physical examination is normal. esp. she asks Q: Can I conceive? Yes Q: What should I do? A:I will refer you to DM clinic since you need a DM specialist. Then. • You do everything to calm him down. So. 3/ A 35th week pregnant woman got the convulsion in the outpatient clinic. then you should talk to the patient to satisfy 3 things: • You are here to help him. The important sign from the examiner is dehydration. Otherwise is normal. He was admitted to hospital because of the laceration in his left wrist. e. Your tasks are: • To discuss what she wants to know? • If she wants. blood pressure or proteinuria. The performer disagrees and always wants to go home with sleeping pills. She has had amenorrhoea. 2/ A man who develops psychotic problems with hallucination. he wants to go home and sleeps with sleeping medication. she is normal. you can outline other contraceptive methods? You must discuss about the S/E.g. delusion and illusion. She did not contract with epilepsy or hypoglycaemia. Report to examiner about her behaviour during the conversation. Now. She has used insulin for a long time and her DM has been controlled very well. no problem occurs. Dx is anorexia nervosa and you must admit her immediately to hospital because of dehydration. So. Your tasks are: • To take history? • Counselling? • To discuss what she wants to know? During the conversation. Obstetrics & Gynaecology 1/ The DM young woman comes to you because she wants to conceive. She thinks her thighs are quite big. such as microgynon 20. Your tasks are • To Talk to the patient to find out the problems? • Mx and to discuss with the examiner about his condition? Introduction. Your tasks are: • To take the history and to explain what happened to her mother? • To take some signs and symptoms from the examiner? • To manage the situation? The mother said her daughter had had antenatal care very carefully without any abnormality. • You persuade him hardly to stay in the hospital. I will introduce the advantages and disadvantages of every kind of contraception pills. not eye contact. complication of the pill. epilepsy or hypoglycaemia (see that rule in the eclampsia topic from the royal women hospital website).3/ A mother comes to you because she want her male baby will have circumcision? Candidate should ask what she knows about the circumcision? The mother will say she has heard from her friend. Candidate must say circumcision is not common procedure in Australia any more. Then you select the pill that is the most suitable for you. talk to the examiner about his risk of suicide (he cut his . a dietician as well as a physiotherapist to prepare you for your pregnancy? Q: What will happen to me during the pregnancy if DM is not controlled well? Q: What will happen to my baby if DM is not controlled well? 2/ A young woman comes to you because of contraceptive pill. Psychiatry 1/ A teenager girl comes to you because of tiredness. Do not forget to make sure she is not pregnant.
but a bit drowsy. Task: talk to the mother. rash (picture from AMC‘s MCQ book page 118). A father brought his 2 yrs old child to see you. A 9 yrs old boy is just diagnosed of type I DM. Temp 40‘c. lethargy and drowsy. What else? –intraosseous infusion. You are a HMO in the hospital. My uncle is a diabetic. Q‘s from examiner: If the child is allergy to penicillin. I know what it is. Circumcision 2. Task: talk to the father and answer his concerns. I just want to know how long he needs insulin. When I have more people (Ideally. He is still in the hospital. if the patient becomes violent. I will come back to inject haloperidol to him. No neck stiffness. 38/40 pregnant woman comes to see you as a GP and asks about neonatal circumcision. Can my child have normal life? Can he go for camping? How about playing sport in school? Diabetes Type I Juvenile – counselling 3. what will you do? A: I will stay with him during waiting CAT team. Q ‗s from the role player: What are the disadvantage and advantage of circumcision? What are the contraindications? When is the best time to have it done? Q‘s from the examiner: If the patient insists on having it done for her child. I‘ll refer……. urine dipstick – protein +++. what are you going to do? Answer: it is patient‘s choice. what will you do? The child is dehydrated. no religious reason. GP setting. Task: Tell your patient about the medical opinion and answer her questions. take the focus history and ask examiner the finding. BP 180/110.wrist before he was admitted to the hospital). how are you going to give fluid? – putting IV cannula. manage the situation. Just husband had it done when he was a child. Over the lase a few hours. the child was not interested in eating. Q‘s from examiner: If you don‘t have Mg SO4. No history taking and physical examination. Q: How to limit the S/E of haloperidol? A: I have to use the minimum dose. History and examination findings: 1st episode of fit. Lethargic febrile 2 yr old O& G 1. You were interviewing a mother of 38/40 pregnant lady who just had a fit in the waiting room. Task: manage the case. Q: During waiting for CAT team. 50 km away from city. then you call CAT team to admit him involuntary to the hospital. what are you going to give her? Q‘s from the mother: Can she have any fit again? Any dangers to the baby? Will she have high blood pressure after delivery? . 1st pregnancy. 6 people (in Murtag)). Now she is not fitting. 11-Feb 2006 Clinical Examination Melbourne Paediatrics 1. Have you heard about DM? – yes. GP setting. If he becomes violent. I will run away because I must be safe first.
Anorexia nervosa 2. A 24 yrs old lady. Task: history taking. A 26 yrs old has 15 yrs history of well controlled IDDM. (long stem). She wanted to get pregnant. She has heart murmur for several years. no CI of OCP. if you give haloperidol. She was asymptomatic. what medication are you going to give? – Diazepam. asked for different types of OCP. GP setting. A middle age lady wants to go for overseas and comes for check up. What medication to revert it? What are you going to do if the CAT team comes late? Psychotic episode with violence – crisis management Medicine and Surgery 1. fine hair. married. GP setting. Q‘s from examiner: What is the cause of MR? Cardiac murmur 2. poor sleep. Tell her 7 day‘s rule. No more history taking and examination. Finding —BMI 14. are you going to look after me? Q‘s from the examiner: When are you going to refer her to endocrinologist. He was having hallucination and paranoid. Task : do the physical examination and tell the examiner about you diagnosis. postural BP drop. For other symptoms. Last week the weight was 45kg but now is 40 kg. This is a young man. Q‘s from the examiner: What do you think about the diagnosis? Patient refuses to go to hospital. Task: manage the case. She can have combined OCP. what are you going to do? Under which law you can admit the patient? While you are waiting for ambulance. which was told by her previous GP. dehydration. what do you expect? – Extrapyramidal side effect. lack of insight. No Ix result. One hour ago a 46 yrs old lady had a difficulty in speaking and weakness in right arm. Task: give her advice and answer her questions. Q‘s from the role player: I want to know how DM affects my pregnant and how pregnant affects my DM. When she was in the waiting room the . a young man had a right wrist injury and lived with other young people. which medication are you going to give? – Haloperidol. If I become pregnant. GP setting. ask examiner the physical finding and give her advice. GP setting. denied any suicidal ideation. A mother of 16 yrs old girl concerned about her daughter‘s weight. Which route? -im. GP setting. Pansystolic murmur at the mitral valve area. Task: Take a history and ask examiner the finding Tell examiner about your diagnoses and the management. not protecting her from STD Contraception request 3. He had problems with his previous employer. You did a limited mental examination as f ollowing. In this case. before pregnant or after? What do you need to check before she becomes pregnant? Pre-pregnancy counselling – diabetic Psychiatry 1. Now you are seeing the girl.Are you going to the hospital with her? Eclampsia 2.
Task: ask the examiner about the Ix result and talk to the patient. Task: take a focus history. Q‘s from examiner: What else do you need to examine? – lymph nodes. All materials included a sling and the ones for figure 8. LFT‘s was GGT . Slightly increase in size and asymptomatic. Task: examine the relevant systems. A letter from his previous GP said that his LFT‘s was abnormal. Dysphasia & upper limb weakness 3. Pleuritic chest pain 7. HMO in ED. Last night in the party after eating a walnut he started having wheezing. ALT. slight rebound. A young man had a history of eczema and asthma.) Tell what you are going to do Acute abdomen 8. A patient has a lump for several years. Task: take a focus history and do an examination. A 35 yr old man complains of left chest pain. Acute abdomen pain. Your diagnosis was nut allergy.AST all increased. You did the examination. GP setting. Task: Explain to him about the diagnosis and how to prevent it happening again. He had permanent pacemaker insertion a few years ago for the bradycardia . occasional bowel sounds. He had peanut allergy at 7.symptoms resolved. Q ‗s from the role player: How long do I have it on? – 3 weeks Do I have a lump over the collar bone? Can I go to work? Fractured clavicle . You have ordered some tests. A patient comes from other city. Patient ‗s mother had a stroke. generalised tenderness of abdomen. Q‘s from role player: If it happens again. A 25 yr old man fell on outstretched hand. Task: history taking and give your DDx. 9 and 17 years old. What test do you confirm the diagnosis. He was not an alcohol drinker. Can it become cancer? What is the complication of the lump? – infection How do you remove it? Subcutaneous lump 4. SOB and urticaria. what he can do next time. (pt on Digoxin. call an ambulance first or give Epipen first? Nut induced anaphylaxis 6. Q‘s from the examiner: How often is the venesection done? What diet? How about the siblings and children of the patient? Abnormal liver function tests 5. some bright red blood in the stool) Ask examiner the finding ( irregular pulses. There was tenderness over the right clavicle. GP setting. had no history of infectious liver disease. Task: read X ray Tell what you are going to do and manage the condition with the materials provided.
But they will assess you regularly. What d o you find wrong with your wife?) o She ‗s terribly forgetful. She is conscious now. was seen by you 3 days ago. Questions: Can I continue my career (yes) What medications you would give me ( first Brofen and take rest) She said. A 40 years old lady. your frequent patient. terrible case. (So when I was doing the reflexes the bell rang). a 60 y/o lady. (It depends.) o I know.) o ( he‘s not happy) Why not? I am her husband. But I can‘t. (I gave up the marital issue. an important player in orchestra. Doctor. A 28 y/o male fell his Left wrist on the floor yesterday and still sore today. tenderness in the sniffbox-------I‘ll do a X-way Examiner asked what‘s your possible Dx? (scaphoid #) Here is the X-way ( it‘s a scaphoid #). (Anyway. His wife. Go ahead. She has the right to make her own decision) (This time he didn‘t come back straightaway. a lot of trouble. The surgeon will look after you and I think you will be fine. 4.) What‘s other change? （peripheral neuropathy）. Task: fo cused P/E. C/O pain. 3. I need your referral.) . She didn‘t tell me anything about it‘ (I am sorry I can‘t tell you any thing about your wife‘s condition without her written permission. it varies individually. That‘s why I came to you.) 2. And I can ask Qu: How about your relation with your wife?) o Quite good. But it must be assessed by the Aged Care Assessment team. This case looks easy but I was not sure the details of the Disease.) Give leaflet and suggested the Internet. ups and downs. I really can‘t take any rest. Can you come to see me next time with your wife together?) o I don‘t think she would come. sausage swelling and stiffness in both hands recently and was tested for ANA.) You mean my hand will return to normal after 8 weeks. You may be interrupted by the examiner because of time saving. A 60 y/o male. various ranges. we‘ve been married for 30 years already. You took Hx and P/E her and found she was normal. I hesitated and asked whether I need to do the power and tone. like the early time?) o ( Laughing) No. But about this issue should ask your wife to make the decision. complaining that her husband found her more forgetful than before.12/11/2005 Melbourne AMC Clinical exam Recalled by Ling Medicine and Surgery 1. I should do something earlier to put her on the waiting list. ‗Dr. This is a picture from AMC which is too clear to be missed.modifying agents. I have to repeat again and again. any other medication can relieve the pain quicker steroids-she‘s shocked. (Do you have any children? How do they think about your wife?) o They agree with me. (Yes. Task explore the husband regarding the marital issue Response to the husband‘s concern From the beginning. First they may see you in the next 24 hours to check the plaster.) o (I know.) (Then I asked ‗Do you have any other concerns) No. (Do you think it is as fresh as before. Do relevant P/E on his lower limbs. but anyway I will refer you to the specialist. I will refer you to the rheumatologist‘ and totally forgot the magic words: early intervention and multi-disciplinary team management. ESR and RF and the results showed that she has early rheumatoid arthritis. He came to ED and you‘re a ED HMO. Sometimes. Patient was shocked and knows that it‘s a very severe situation because her mother is 62 y/o and has RA for many years ( I explain early stage. I can‘t do the assessment. Last time I force her to come.( I understand. Do as you want. (Oh. the blood circulation and then they may check in 2 weeks when the swelling fades away and sometimes the bone may die because of the poor blood circulation. Examiner asked: what do you want to check first (peripheral vascular disease). (I failed this station. but I think every couple are the same. I am afraid she may make fire at home when she cooks. It‘s me to look after her all the time? (I can understand. modern medications and more therapy will keep the function well. I think she needs to stay in hostel. (I did inspection and palpation for pulses. Poorly-controlled DM for several years comes to you for check up. Talk to the patient. no steroids. It‘s patient‘s confidentiality. Today she comes to you (a GP) for the result and tell her your Mx. order your Inx and Mx On P/E. Then examiner remaindered me to wash my hands. I can‘t give you any information about your wife. Finally the bell rang. Dr. then vibration loss below knee and also proprioception loss on both big toe joints on a role player. he complained his wife and asked ‗what did you find wrong with my wife. but in short term.Go ahead ( I started with pain sensation check for stocking distribution which disappeared below the mid-tibia. (I explained and refer him to the Orthopaedics surgeon) His Qus: What are they going to do for me? (They will put a plaster for you) How long do I need to have it ( about 6-8 weeks. who is your infrequent patient. We‘ve been married for 30 years. came to you (GP) today wanted to enquiry about his wife because he found she is getting more forgetful recently. It should be OK. My mom took it and I know there are a lot of SE.
Task: relevant Hx adverse effect to the next pregnancy and evaluation。 I asked and give possible effect on the future pregnancy: how many weeks of pregnancy（14/52）. alcohol drugs Qu from role player: Will it affect my fertility? 10. . Any anti-D after the procedure (not sure). P/E: Bp155/96. A 50 y/o lady C/O hot flush and irregular periods for 11 months. Admit the patient. multidisciplinary Mx. Any diseases: DM. No weight loss or discharge. All P/E are normal. (? ED or GP setting) Task: focused Hx P/E and Investigation from examiner Read an ECG at 7th minute This is a quite confusing case.) Which degree of the block(4 to 1). How is the ECG? (ECG was given. the surgeon just said the changes exist in the whole large bow which suggests ulcerative colonitis without giving a report. What‘s the complications (bleeding. Task：talk to patient. A young male had bloody diarrhea for 6 months and had colonoscopy done today. DDx Answer patient‘s Qu Again. no tinnitus and spinning feeling. It‘s an atrial flutter. No bleeding. Blood group (―O‖ negative). No target organ damage symptoms (visual problem. Smoking by 20/day and alcohol by 4-5 glasses of wine since teenage. not related to exertion. heart and lungs are all normal. about 4 weeks a cycle). which hospital (RWH)， any fever after that(no). Task: focused Hx P/E from Examiner Mx Qu: What‘s the reasons for my headache？（DDx）( Then talk to the examiner) P/E (T: 38. A 28 years old lady come to you for advice of next pregnancy regarding that se had an abortion 2 years ago. 8.( bell rang)． 6. SOB. smoking. How about the periods since then ( as normal as before. can be caused by infective inflammation. Qu from role player: How about my diet ( low fibre diet) Any operation now ( not this moment. A 51 y/o came to ED with severe right upper abdo pain. patient has a Qu. a typical acute cholecystitis case. Blood culture) What else? (CT head). The bell rang. Examiner asked: What‘s the likely cause (Tachycardia) Which one (maybe sinus tachycardia. so I fail this station easily and completely. Explain ( lifetime situation.when get her first period after the procedure( a month)； any check up by any obstetrician (Yes). what else? (lumber puncture). O+G 9. Blood clotting problems. p150. give AB.5℃. The patient brought the picture of his colon change to you (a GP). His BP 155/96. Palpitations sometime happen at night. No Hx of heart attack or stroke or thyroid disease. drinking a lot of caffeine. I can‘t remember the other details. Task: Mx (no further Hx and P/E) I was on the wrong track and gave her OCP. C/O terrible headache since yesterday and getting worse. pain in calf or body weakness). No medications. no chest pain (?). like germ infection or Crohn‘s disease. But the distribution of the inflammation can tell the difference). HTN. bacteria staining. I hadn‘t finished the whole Mx ( Notification). such as eye problems. Task: focused Hx . perforation and higher risk of bowel Ca. I think I asked too much Hx. culture and biochemistry). Other organs can be affected. skin changes and liver problems. What tests are you going to do with the fluid (pressure. no rashes) What are you going to do for the patient (consult my Reg or senior Dr. same partner (yes). How is about my two kids (9 and 11 years olds) ( I will give all your family members rifimpicin for prevention). mouth ulcer.5. regularly. Unfortunately. not sure). 7. Why? (Rule out bleeding). OK. Hx. A 60 y/o male C/O episodes of palpitation and dizziness recently. sometimes may need surgeon) Can it be other situations according to the picture? (the picture suggests inflammation. it can be well-controlled) Admit to hospital at this moment.) What investigation( FBE. Two children (20 and 22 y/o). neck stiffness. A 30 y/o male came to ED.
11. Today she came for the results.Rest pain d. So that‘s fine 13. C/O that her daughter has some rashes in her genital area in the last several weeks and it‘s getting worse. which are normal. which is compatible with 8 weeks of gestation.Ulcer at Halluces B .) 14. A father came to you. Pap smear is normal. no burning sensation or frequency passing urine. Poor sleep and always wakes up at 3 Am and can‘t go back to sleep. She complained right lower intermittent abdo pain for a week. He found one lump in his right groin area. which comes out when he‘s crying and goes back when he‘s sleeping and another lump in his tummy button Talk to the father about the Mx (totally repeated case) Psychiatry 15.Hair loss on lower limb 2. Appetite is gOOD sAMARITIAN . Task: focused Hx. 2006 4:43 pm Post subject: --------------------gorani Guest Posted: Fri Sep 29. do P/E and do Investigations. 2006 12:53 pm Post subject: -------------------------------------------------------------------------------all of the following are the signs of Ischaemia of the lower limb EXCEPT: A . I said that ‗I am not sure about the diluted vaccine. Mx Hx: A dull pain at 5-6/10. worrying about his 5 months old son. What is the complication of Pertusis vaccine (encephalopathy). but you said you will check the book for her. including. I need to call Gatehouse now. US: normal pregnant sac in uterus.Indirect I . A 60 y/o lady with right lower abdo pain for 6 weeks and lost 5 Kg in the last 6 weeks.They will remove the cyst now? (I don‘t think so).Guest Posted: Thu Sep 28. A cyst of 5 cm was found in the right ovary. P/E: Vital signs are normal. P/E and Inx from examiner. no PHx of PID or STD. A painful lump in the groin of sudden onset in an otherwise healthy young man is MOST LIKELY to be? a. Only superficial tenderness in the right lower abdo. Hx: The RL abdo pain for 18 months and getting worse in the last 6 weeks. Task: Give the mother your Mx plan. Role player‘ Qu: First she asked me to talk through the schedule of vaccines from 6 weeks to pre-school Is there any reaction after the vaccines ? (Yes. ( GP setting) Task: Take HX for the psychiatry cause Give the patient your DDx Explain the nature of her condition and Mx. (It looks easy. blood tests and colonoscopy. no discharge.Intermittent claudication c . I kept repeating that they will take Hx. At weekend he r daughter stays with her ex-husband but she refused to go there yesterday. planned. She has a new boyfriend moved in 5 months ago. no smoking or alcohol. not torsion. Is there any condition you should not give vaccine (Children with encephalopathy caused by pertusis must not be given any pertusis vaccine) Some parents suggested to use diluted protein (a natural way of immunization). Not sure what else they want. (GP setting) A 25 y/o Ph D student was 8 weeks of pregnancy. Direct Inguinal hernia b . no diarrhea. Immunization advice for a mother with a 6 weeks old child (her first child). She went to see the doctor (P/E was normal) and was investigated. NO particular event 6 weeks ago. Then she told me she has no Qu for me. Is that the same as the immunization schedule (I haven‘t heard this before and not sure its effect but I will check this for you. not ruptured. no fever. some children may have mild fever or unwell). Mx: I will refer you to the obstetrician. She suspected her daughter was sexually abused by her ex-husband. Is it recommended?‘ The examiner told me ‗No. Ulcer above medial malleolus *** e . Speculum P/E: Os is closed and PV P/E showed tenderness in the right adnex.1st pregnancy. The question here is how to explain this 2-3 sentence in 8 minutes. She devoiced for a while and looking after her daughter. A young mother bought her 4 years old daughter to your suburban clinic. Paediatrics 12. Patient asked:. no pregnancy reaction symptoms. The child is all normal with P/E and growing well. －How to prevent it? (Paracetomal).