MELBOURNE AUGUST 10fJ6

Obstetric$ and gynecology

Casel

A 21 y.o . .female presents to you GP practice, complaining oJamenorrhea for .few

months. She is obese BM! more them 30 (she has no hirsutism or acne) Appropriate
investigations were peifonned.

Task: Take rele lx/rom examiner, expJain to the pt res:uJtr. 0/Ix plus her condition,
Mx the case and answer pt 's questions

Pt's Q: Why my periods are i"egular?

Can I have children infuture?
OCP questions will be asked ifyou won't say about it yourself.

From Ix it was clear she ha~ a PCOS (Us, honnonal studies, B8L)
Her sister suffers/rom same condition.
For some candidates this pt said that she is on OCP, for me she didn'l say it so 1
prescribed it to her as well as refer to gynecologist counseling. Loss ojweight
program is very important.

Case 1
A 26 y.o. female 4 days postpartum present to your GP setting with 39 C fever, no
other complains. She hadforceps delivery. Her baby is normal on breast fteding.

Task: Take rele Hxfrom pt 4 minutes, take PEfrom examiner, order appropriate lx,
Mx the case. Answer pt 's questions.

From her Hx she doesn '( have wound probs, no vaginal discharge apart/rom normal
lochia, no cough or difficuLty in breathing, no varicos veins, no 'UTi symptoms, breast
slightly engorged

From examiner GA normal, VS are normal apart from T 39C, all other systems are
nQrmal. Breast; eXaminer told me that she has redness and tenderness on her right
breast. Other candidates I have talked to surprisingly didn't get this infonnation.

My Dx was ~ 1IIRStitis 1 gave her ABO orally recommend on complete breast

emptying after each/eed, FU in two days

Pt's Q: Should J stop breast feeding?

Will ABO effect my baby?
Case 3

A 25 y.o. lady 7/ 40 feels well come to you to consul about future way of delivery. 2
years ago she had CS due to fetal distress on labor. This time she wants to have a
normal vaginal delivery.

Task: Talk 10 pt, answer-her-questions.

Pi's Q: Will I have CS again and what my chances to have it?

Can I have labor induction?

It was mainly reassurance station.

Psychilltly

Case 4

A 50 y.o. woman come to you to askfor certiphtcate to change her apartment because
she has problems wiih her neighbors. She also has contact dermatitis on her hands.

Task: take Hxfor 6 minutes, report on MSE, DDx

Rash on hands ;s from excessil-'e »'Oshing. Neighbors are coming and massing
around She lives alone. Two years ago was Dx-edwith some psych condition she
doesn't know which. was taking drugs, she doem 't know the name, now not on drugs.
No suicidal thoughts, has visual hallucinatiorlS and delusions. She is not depressed a
bit anxious.
No flight of ideas, orientated, lack of insight and judgment.

DDx Schizophrenia
Bipolar disorder
Organic condition
Substance abuse

CaseS

You are intem in ED going to see a young woman who came to ED yesterday c. o.
sever abd pain asking for pethadine injection. She was investigated and reviewed by
registrar. No organic abnormalities were found.

Task.- talk to the pt Mx the case

Critical error is to give her pethadine

Pedilltrics

Case 6

A 5 mn old baby boy come to ED with his mother c.o. two days fever 39C wheezing
and dry cough. He doom 'I eat well, mother changes his nappies less often.
Baby is on breast feeding.

Task take rele Hx from mother PEfrom examiner, A1x the case and answer the
questions.

It was the case ofbronchiolitis

Mother's Q: can it be asthma?

EXilminer~s Q Wilt you need to do an Xray?

Case 7

A 6 mn old baby was Dx-sed with Y.SD by echocardiograph. She is thriving well,
weight and height are on normal centile. She is eating well.

Task Explain the condition to father, answer his questions

Father's Q: Is it serious condition?

Does she need surgery?
What about immunization. can we do it?
Wilt my next child have the same condition?
1~ anything my wife did during pregnancy that can cause it?
How can J know if she gets worse?

Case II

A 4 mn old baby fully on breast feeding presents to your clinic with his father c. o.
diarrhea and vomiting. No other Symptoms.

Task: take rele Hxfromfather, PEfrom examiner, talk tofatherabout Dx andMx,

answer pt 's questiOns

This case is Viral gllStroenteritis

Pi's Q: Does my baby need to be admitted (no child was normally hydrated, no
fever)?
Will you give him ABO?
Why my child has this condition even on fully breast feeding?

Medicine and SlUgery

CtlSe9

A 40 smth y.o man come to your GP setting c.o. tingling and numbness ofhis right
handfro few weeks. He is teacher at school. No other complains.

Task: short rele Hx

Perform appropriate PE, talk to the pt about Mx

it was case ofCupral tunnel Syndrome.

Case 10
A young male had an operation for perforated peptic ulcer 12 hrs ago. His VS are
stable he was given 500 ml of5% Dextrose IV, nil by mouth.. He lost 600 ml through
nasogastric tube, no urine output.

Task: rele Pt examination, Mx the pt, examiner will ask you 'to write some
prescriptions for nurse.

Examiner's Q: Will you give him diuretics?

elise 11

A 45 y.o. man hasfound himse(fhavingface asymmetry in the morning, pictures were

presented ENT are normal.

Task: tell the examiner what condition pt has (there were more pics given inside the
room and it was Bell's palsy case)
Explain to the pt his condition and talk about .A/x.

Pt's Q: is it a stroke?
/)() )!QU think I should massage my face?
When will i/ become beller?

Examiner's Q: What part offacial nerve is affected?

What dose ofsteroids are you going to give him?

Case 11
A 65 y. o. woman come to you for CT results. She c. o. back pain. Fatigue. She has
normocytic, normochromic anaemia.

Task: tell her CT results (Liver metastasis), talk to her about her condition and futher
Mx.

Pt's Q: When I'm going to die

Examiner's Q: what other Ix will you do on liver?

This case was braking bad news case and to show empathy was very important.

elISe 13

A 50y.o. woman has long (about fOyear) HxofDM, on MeifOrmin. Her urine
glucose is +, This stem wa,S" quiet ltmg and all about her Dl\!{ Hx,
This time she c.o. reducedfeeling in herfeet.

Task: per/arm LL e:ca1llhuUion jar 6 min, then tell examiner what Ix yau wauld like
to order, and which specialists she needs. to see.
Case 14

GP setting your pt was Dx-ed with Hodgkin 'slymphoma, he has only one L."f../ involved
and only on one side

Task: talk to the pt about his Mx and side effects of chemo-radiotherapy. Answer his
Q.
Pt's Q: Should I take days offduring treatment?
What is the prognosis?

Case 15

A 45 y.o. male 6 mn ago had a car accident and has broken leg, now presents to you
with itchy scaly rash on his arms (around elbow) and legs behind knees, the hair
growth area is involved.

Task: take rele Hx from Pt, explain condition to pt, Mx the case

PI's Q: Is it contagious?
What can I use jor my hair, it is uncomphortable to have this look.
Can sun make it better?
Will this condition effect some other parts in my body?

This was Psoriasis case.

Case 16

A young male nurse come to you as a GP c.o.jaundicejor few days, mildfever

(3?5C), right intercosials space tenderness.
Two weeks ago he had sore throat and .,...'Os treated by his doctor with Augmentin for 7
days.

Task: Take Hxfrom pt, PEfrom examjoner, order appropriate lx, tell examiner your
DDx

DD: viral hepatitis A, B or C

EBV (infectious mononucleosis)
Drug induced hepatitis.