29 APRIL 2006 MELBOURNE

1. Post Natal Depression

The 28 years old woman came to your GP practice after delay 4 days from appointment.
She just gave birth to baby 6 weeks ago has another 10 years old child at home. She
complains doesn’t have enough energy and can’t organize herself.
Take relevant history
Explain the condition to the patient
Management

2. Iron Deficiency Anemia

Woman 48 years old menopause came to your clinic to get result from her blood test
(attached, suggested iron deficiency anemia).
Ask relevant history
Explain the condition to the patient
Management

3. Side effect of antidepressant

Woman came to ED feels nausea, vomiting, jittery and unwell. She’s been on
fluovoxetine for 3 years and then she came to ED. The doctor gave her Sertraline.
Take relevant history
Management

4. Septicemia
Father of 4 years old child came to your surgery because his child looks very ill, fever and
developed rash (as picture in AMCQ book page 118).O/E GA: looks ill, VS: BP 100/60
Temp : 40 degree RR: 98
Explain the condition to the patient
Management
You know the song guys, explaining condition to the patient, notify health department,
prophylaxis for household contact.

5. Renal stone
28 years old came to your surgery after having severe abdominal pain 2 hours ago. The
pain radiates to his right groin and testicle. He had similar pain 2 months back.
Explain the condition to the patient ,Order the necessary investigation, Management

Examiner in this station was very nice. I explained to the patient about stone in his urine
passage. I said to examiner I want to order for FBE, U&E, MSU culture and microscopy,
abdominal X-ray.
Examiner asked:
 What else the investigation you need to order? CT KUB
 What stones do you think it is? Calcium, Phosphate and Uric acid.
 What from the blood you want to look? (Examiner pointed the stones so I understand
what he wants) Serum Calcium and Phosphate.

Role player asked :

  Why do you think I’ve got this condition? Because there’s possibility that you
didn’t drink enough water.
 What else? (Examiner stopped him and said okay you finished earlier you can wait
outside.

6. Management of migraine
The woman 38 years old came to your surgery with severe headache and vomiting. She
had a history of migraine 2 months ago. The CT brain result doesn’t suggest any tumor.
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. Then I gave her an advice
about lifestyle modification reduce wine, caffeine, smoking, cheese, etc and
paracetamol and antiemetic tablet.

Examiner asked:
 What if she doesn’t get better? I’ll refer to neurologist and they might give her
sumatriptan or ergotamine. You as a GP can give her she said.

7. Bitemporal hemianopsia
The man 48 years old came to your surgery. He complained of having visual
disturbances. Two days ago he had accident because he didn’t see a truck coming from
the side of the road.
Examine the patient eyes
Order necessary investigation

I checked for the visual acuity, visual field and funduscopy. That real patient had visual
lost on the lateral side.
I said to the examiner that he has bitemporal hemianopsia probably due to compression
of optic chiasm. (Pituitary adenoma)

Examiner asked:
 What are the sign you looked on the patient?
 What investigation you want to order? FBE, prolactin level, blood sugar, lipid
profile, CT brain, 24 hour serum cortisol level, TFT,….
 What else?
I wasn’t sure about this station because examiner kept asking what else? Then the bell
rang.

8. Contact dermatitis
The 32 years old man came to tour surgery. 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, he doesn’t have any allergy, hay
fever or asthma, as well as family history of those conditions. He is a builder and
 recently he worked with cement. I explained to him that he had an allergy probably due
to cement complicated by bacteria. I gave him prednisolone and antibiotic. I talked
about referring him to allergic clinic to have a test done and avoidance to the materials
that you allergic to. Then report to your employer regarding his condition. 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…..

9. Gastroesophageal reflux.
The mother of 1 month old baby came to your surgery because the baby always
vomits after feeding. The baby grows and develops well. Mother thinks there’s
something wrong with her milk.
Take relevant history
Ask examiner examination finding
Management

I took further history, the baby’s well so far. Then explaining about GE reflux and
drawing a picture. I reassured mother that’s nothing wrong with the baby and the breast
milk. And role player asked are you sure that’s my baby’s okay? Bang! I realized I
forgot to do PE. I said sorry to examiner then asked GA,VS, ENT, heart and lung,
abdominal examination. All normal. Then I said to the patient your baby’s normal,
usually this condition will clear up by itself when solid is introduced abut 6 months old.
If the condition doesn’t get better you can add corn flour to your milk or gaviscon. I’ll
follow her up in 1 week, but if you have any concern come back to see me.

10. Examine the shoulder and nerve injury.

The 18 years old student playing in basketball competition. He had shoulder dislocation
on the right and nerve injury. He already had an operation fixing it up 6 months ago. He
came to your surgery asking you when he can go back playing basketball again.
Examine the patient
Advise the patient about returning to the competition

The examiner was really old and very nice. I started examine the shoulder.

Examiner asked:
 What nerve could be injured? Axillary nerve. Go on examine the patient. I
examined for sensation on deltoid muscle and power (abduction)
 What else? The bell rang… I was thinking about radial nerve as well, but not sure.
So please check the books.

11. The woman 26 years old came to your surgery complained of stopping her period after
two courses of oral contraceptive pill.
Ask relevant history
Ask examiner examination finding and order necessary investigation
Explain to the patient
 From further history the woman stopped her period suddenly, doesn’t have tummy pain
and vaginal discharge. No past history of STD, Hypertension, DM. Family history (-). I
asked examiner for Pregnancy test urine and blood, FBE, TFT, FSH, LH, prolactin
level, swab. Examiner said good but they are not available. Huh? Okay, I said to the
patient I’m waiting the result of the test I ran. If there’s abnormality I’ll refer you to
specialist straight away. If they come back normal we’ll wait for another 3 months if
your period doesn’t come I’ll refer you to sp. It could be due to stress or side effect of
OCP.

I wasn’t sure about this case. Check it again in the book.

12. You are HMO in Obstetric and Gynecology department. 41 weeks primigravida came to
ED. She is in labour. O/E cervix dilated 3 cm LOP (in the morning LOT, means
tranverse) and meconium stained. ObsGyne registrar and consultatnt are not there. You
have to manage her by yourself.
Ask relevant history
Ask examiner about examination finding
Manage the patient

13. Primigravida woman 28 years old came in for routine check up. Four weeks before you
checked fundal height 26 cm. Now she came to you and her fundal height 30 cm
Take history
Ask examiner examination finding and order the necessary investigation
(Examiner only will give you what you ask)
Manage the patient

14. Weight reduction

Woman 43 years old BMI 33. She came to you for advice on weight reduction
Advice the patient
Answer patient questions regarding medication to lose her weight.

15. 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, otherwise the baby is
fine.O/E : There’s umbilical hernia 1cm, both testis are in the scrotum
Ask few clarifying questions
Manage the condition

I explained and drew a picture as usual. Then referring the patient to a surgeon and
saying possibility of twisting if it’s not corrected and should be in two weeks time. The
umbilical hernia, it’ll reduce by itself when the child gets older but if it doesn’t when
the child 5 years old, need to have operation done and don’t put anything on it.

16. Spirometry
28 years old man with a history of asthma came to you. He has symptom free for 2
years. He hasn’t been using ventolin in the past 2 years.
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 . I had no idea at
all. Felt really bad. Read it in the Talley o’Connor.