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AMC Clinical Retest-Sydney:-ll:Mar-2005

Station 1.
45 yr old lady recently developed palpitation and dyspnea, the symptoms are exertion related. She had a blood test, which is
shown: f r.;..:1

Hb 97 (120·1501 MCV: low, MCH: low (can't remember the exact number1
Blood film: microcytosis.

Task: Hx, PE (from Examiner), investigation (from the E and advise further1

Hx: this kind of symptoms appear gradually, exertion related, no heart problem, the woman sleeps well, and no evidence of paroximal
dyspnea, no history of ankle swelling. No change of color of stool. The lady is not from any other country and no family history of &.~. ill.".,-y
anemia. She is vegetarian, but do eat some chicken and fish. Her period is normal. She is exsmoker (?, maybe confused with some
other patients), but not on alcohol. No history of polyps and family history of bowel cancer.

PE: everything is normal, PR: some old hemorroids, FOBT: negative,

Investigation: the iron profile is low, 812 and folate normal.

Advice: two possible things, food, and something Ytfong with your bowel. I would give you some tablets to restore your iron, and also
STange some investigation, it is that we pass a tube into yotl' anus, and m see exactly what's going on in your Ia'ge bowel.
~d fnQat-- (,~ , kicJnt~ .
E: her food style is not ikely to be a cause. what would you do if colonscopy is neg.
I: STange endoscopy for the upper GI
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~=no~ girl (boy?) hat recently been diagnosed as 100M. the mother Is wonied and comes to your clinic. Task: 88sess the
mother's knowledge of OM and insulin. and educate the mother. H(jr<i':t ('... ,..... .1,
.sUi«'CI'1
The mother gave out a 1st of her baby injection 1st and asked some questions. Basically in this station. I just followed the mothers -htJ Yl~'
uestio olt.mAclo<.b.
q ns. .... . .' ~ I-l...rO<.I.,~c"r-.-.r('. poJp :t-G. h L 't")
""'':I "tW't- ~I .. ~ fI Of
Why use insulin, what is ictpid, what is protapane (spelling is not correct), wh~1M ~erse effect Of,.i!JSII~I1h.how can I know if my hl#~t.
1

child is insuln overdose, if overdose, what should I do. how can I know if her g "'(;~W8}/~~"tn,IIed. hOW o'ft8n do I f\aVe tcf S8iY6u. pell j Cl.d 17:'-"" ~,IW.;
any significant disease if her glucose is not under controlled. when she is sick, can she reduce the insuin dose, ~ f1Q • . Lee .'
c.. ('Y>;lcI -1 8A.t1 S'CJ~ 9~eb .
Maybe some' other questions but most of1hem are easy to cope with 1'}C)('nff (0 "" 0-
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'. station 't. rest _ <j\ " O..,c...IC<n C'-'J~ ( L.~. ~
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~n4:,'f .. "'jHlt.9( ~~_ Mt.iJh...GJ H
) 20+ yr girl had lower abdominal pain. She had a ultrasound, which shows that two cysts in the right ov~~u~n® LIV> f' 1'0.
'"- rnm. otherwise norma~ pregnancy tnt neg. ' --.L . \·uuc.ft.., ('.,h...
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task: Hx. PE (from examlner11nvestigation (from the E and advise further1 ('h~~ IJJc. ,I"> 6 L,ji..
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Hx. the pain stats nund 24 hours ago, mild, middle central, and now over. She is in middle cycle, she had this kind of pain Cl'ound
ItI\ four months ago and the pain simply went away. Pap smeak 2 months ago, normal, sexually active, just one partner. No history of STD.
No urine symptoms.
,~

.k(,. PE: everything normal, no fever, no pelvic tenderness. . ' It....

dt+ Q.,..c;fc.>n -':,1I;c.1A -"Ur fuu a glh,f'} OM!- q bId ml)~d ( tc,lI;w/c.Jt ~ ui ~ .J.; U;O : A.d.l<. Hd "nl-r-
Advice: could ~~me~ normal response when you ovulate. For that two cysts, I wil~to ~Iogist to look after, if they do P 1:J·
disappeCl'in a few months, they may pass a tube in your tummy to see what's happened. . - ~ ,..u.<; pt ';~ 0' - ,
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h I -. .,. d -s ,-
lOng run
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(maybe the referral is not necessay, I don't know). C>J ",lOr> lY) df+
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./-Stat1onT ~ "- r-:- . . . -.- .- - .-- . -
A patient had an abdominal pain and you arranged a CT scan.
Task: Hx. PE (from examlner1 give ~O. management

Hx: typical of U coUe. The man is 40, smoking history (Now I forgot, with station 1, one of them must have a smoking history. but doesn't
matter). Drinks normal water, no special in the job (saw worlter), but no history of heavy metal exposure ...

CT: ureter stone,

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AMC Clinical Retest-Sydney~Tf':Mar-2005 (.. 0» I "l r,r)of)~.-,('_.LJ in fj. I~ ( '''no :;uch oJ

()" L (e Ul'll c¥ dot:. , {V)r.JU' -> /v,u {v,r>')(lO" (,~ ~

DD: MI, cholecystitis, cholangitis, drug seeking behavior, ,M ,e1j C>I ck'l' l cor'lunive>.ird ('j;Y~ •..mr(),. hil(>r»"y-, 0('(,4
0-,-1->0 ~J.,n~ ('n~ 9rr>n./1 a",,~ .:!~ ~'--t'c/
Management I explained to the patient what happened, but bell rang, I just told the E that management should be analgesia and
hydration.

(I didn't have a good time scale in this station, just gave me one other minute, I would have done it perfectly well., bu~ I was just
extremely unlucky).
.. -- ' - ' - " - ' - - - " - "

. statlon6;:1'~ 0 0>«'101 h
. The man Just developed a severe asthma, and treated in your hospital, he is a spray painter and started work and 15, and hE(!) 'I'"W' lcdv>-'
had asthma at 16. (n-J )
Task: assess the patient's caule of asthma, assess his knowledge of asthma, and future management plan. ~ Pt::I=R (".uHf'

I pointed out his job is possible factor for his asthma, but I forgot to suggest him to change job. (This maybe a critical error., hope th\~ ~-/q:j,~~~:,?
examiner is a good man.) The other part of this station was mostly educational, what is asthma, how can I know it's severe, and what@ A (i-;" ,., pion
need to do (pEF<8O%, 60, 40%), There is a puffer and spacer on that table, so I showed how to use them. However, it's not in the task,
maybe I wasted my time.
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/ :-SWiofl 7. ~
'You reie~ your patient to a neurologist, who performed CT and several other blood test: Vii 812, and some other (forgot).
The CT shows brain atrophy, blood tests are normal. The neurologist diagnosed asAizhelmer'1 dis, His son/daughter is
coming to see you today. You know his sonl daughter did hIVe a strained relationship with the father.

Task: counsel the patienfs son I daughter, advise. 3"' task (forgot~

In my station, it was daughter coming to me. Basically, counselng the daughter is to explain !he result of CT and blood result, and the
Alzheimer's dis, and symptoms.

The daughter then described some symptoms of his father. Looks Ike depression, anct--1ISked some medications. I told her it would be
best if I can see the patient first (

Daughter said she was very busy. I told I can do a home visit, and I win contact other people social worker, occupational therapist, to
make home improYement.

Daughter:ls there any medication for my father's dis? I think he is now very depressed.
I: There is no medication ~ an 'fOAl father's dis. I mentioned some meds recently pub&shed to slow down the progress of Alzheimer,
but currently probably not used in Austraia. The best thing to do is home improvement (bathroom, toilet.). Ifs possible that your father
also has dep, but I need 10 assess him first.

Daughter: Wth an this help, I think he can ive perfectly by himself.

I: I will come to see your father first, and there are a lot of people who can help (social worker... ), you can also find some useful
information tom Alzheirmer's foundation. .

·~nl.test

\Station 9 (my starting station).

You are In the ED and a young man was just brought in, unconscious. He just moved In a wk ago. His flatemate and you don't
know too much Information of him. His airway is patent, VItal ligns (I forgot).

Task, assess GCs, PE, and tell the E what you want to do.

I didn't do well in this station. --------_._ -.. .... . . - .' .-. .. __ ... _--_ .._-------_.._--- _ .... -

, \.statlon 10.
"Alidy came to you a few days ago, with painful leg, and you suspected DVT and ordered lome tests, she has two relatives
with DVT • Today she came back for the result.

Task: ask the result from the E and explain your result to the patient and answer questions.

Thrombophic saeen, clopla' ultrasound {confirmed DVT},

The E is not very kind. At the beginning I didn't mention the thrombophilic sasen, and later I mentioned tha~ he was unhappy, and said:
"why didn't you ask this before, ok, carry on", ~~on't think I can pass this station.