April

Stations
21/04/2021 5:13 pm

April
7 April
1. Prescription Palliative care
2. Simman sepsis
3. I.V. Cannula post appendicectomy
4. Foley catheter
5. Breast Milk jaundice
6. Tonsillectomy criteria
7. Gender dysphoria female to male
8. Psychosis son, mother concerned
9. Ischemic stroke post operation brain tumor removal
10. Medical error hip fracture
11. Premenstrual syndrome presented with Headache
12. DM learning disability
13. Pregnant 5 week no fetal heart on tranvaginal us with brown discharge
14. Postural hypotension
15. Chest pain, on heroin, pcp?
16. Clostridium difficile

8th april
1) HTN pt lifestyle modification
2) high BP on 2 settings (160/80), BMI high, smoker, Mx
3) Angry son,mom got HF
4) DKA pt wants self discharge
5) URTI pt wants antibiotics
6) 15 mnth delayed walking
7)BBN - ductal CA in situ
8) Ascites - exam
9) simman - Asthma
10) End of life care
11) Glucoma but no pain, redness( open angle?) citalopram
12) SAH
13) Raynaud disease
14) Urinary incontinence
15) Anc breech
16) Daughter struggling with care ofdementic mother

9th april 2021

1.Per speculum teaching
2.Hypoglycemia simman, elderly pt skipped breakfast(not diabetic)
3.Epi pen technique
4.Low sodium( copd) pt, looked drowsy/sleepy. Pt came with tiredness
5.Young girl nausea(missed period)
6.Depression telephone
7.Varicose veins nhs policy for free surgery( pt wants surgery) telephone
8.Skin lesion on ear(cancer) pic given( telephone)
9. Gout?(pt big toe pain beed steak)[=-08
10. Pyloroc stenosis?( pt with projectile vomiting)
11. Sepsis or elderly talk to home care assistant
12. Child with chlamydia in eyes counsel mother on phone
13. 3 yr old baby girl with urinary problems and fever( worried mother)
14. Pt did psa(slightly increased) no symtoms. Negotiate
15. Missed MI ethics
16. Post op bleeding,husband called ( ethics station, no error done)

10, 11 OFF

12th April
- [ 1] Young man ureteric stone
- [2 ] Young man combined station unilateral painless hearing loss.. ?Wax
- [3 ] Postpartum depression
- [4 ] Simman UTI Sepsis
- [ 5] Pre op cholecystectomy counselling
- [6 ] Heart failure post MI (breathlessness)
- [ 7] Old lady urge incontinence
- [ 8] 3 y/o needle stick
- [9 ] 3y/o autism already diagnosed, mum has some concerns
- [ 10] Pneumonia X-ray mix up (patient’s actually fine)
- [ 11] 38w preg pre eclampsia
- [12 ] Epilepsy non compliant on meds
- [13 ] epididymorchitis combined
- [ 14] Coeliac diseases TTG done, for endoscopy
- [15 ] Early stage Breast cancer young patient doesn’t wanna do surgery and chemo cuz afraid it won’t work / side
effects

13 april
Stations 13 April
1-Simman Anaphylaxis
2- Abdominal Examination
3- PSA request ( per rectal combined )
4- lung cancer
5- Euthanasia
6-Lump in neck
7- Hemangioma
8- levothyroxine angry daughter
9- Smoking cessation
10- DCIC breast cancer BBN
11- giant cell arteritis
12-optic Neuritis ( MS )
13- trigemminal Neuralgia
14- Ankle pain removal
15- Medical Errors
16- bullying ( lesbian) panic attack

14 april
1.Acute limb ischemia
Same old story, She's calm, Monitor showing hypertension & AF. Auscultation of heart sounds is kind of irregular
Take history & I think you should examine leg first before chest (it was her right leg covered with whitish substance)
Check for 6Ps
Don't forget to rule out PE, Dvt. Travel hx, bleeding disorders, COCP, smoking

2. Hydrocele,Testicular exam
Came with c/o of left testicular lump
Some said it was epididymal cyst although I said Hydrocele 🤦 (Pls learn the difference)
Concerns: Is it cancer? Will ask earlier

3.Breech examination
Nurse examined 5 weeks ago & it was breech
G3P2+0, Normal deliveries previous 2 pregnancy. Nurse already checked BP
On Examination, Baby's cephalic. Nice calm lady
Concerns
1. If you ask her if nurse explained the meaning of Breech, she will say no.
2. Why the nurse told her it was breech & you telling her it's cephalic, Why the difference?

4.STI- Male with penis discharge

Married to a lady with kids for 15yrs I think but having an affair with a male.
Pls spend some time in sexual history
He's not giving good eye contact after telling you about the affair cos he won't tell you if it's with a male or female, Pick
the cue & ask him if he's alright
Concerns
Hope you won't tell my wife about our discussion

5. Daughter has depression,fatther wants to talk.

I think this station is about breaking confidentially. Daughter is on treatment for depression & given anti depressants but
father wants to know about treatment, said daughter is not talking to him. Ask him what he knows so far, he will tell you
that he knows his daughter has received anti depressants. Try to profer solutions about how to contact daughter but
don't disclose about further treatments or any other info apart from what he knows. He is really persistent.

6. Chicken pox child, mother call

Mother sends email of body rashes, When ypu tell her it's chicken pox, he will say she thought so too. Nice lady
Concerns:
When can he got to school?
Will you give him antibiotics?
What else can I do for him?

7. IBS/cancer - increased poo and blood,do not want to talk to gastro.

Came with c/o of blood in poo (weeks or months, can't remember). Rule out everything.
Surprisingly she doesn't want to go to see specialist. I asked any reason why? She said she doesn't want, let's do the
blood & poo tests first, that she thinks it's it's just an infecnon. I said seeing a specialist will benefit her but it's snll her
choice. 🤷

8. Hypothyroidism - counselling
Blood tests showed hypothyroidism
After taking history (weight gain), rule out other causes, Mood is low 3-4 on some days & 7 on good days, ruled out self
harm. Told her tests shows/suggests she has hypothyroidism. She doesn't know what it is, so explain. Tell her about
Levothyroxin. I didn't get time to address mood

9. Bbn- ica - palliative care

Father was brought in with stroke. Said he knows & his father had a headache earlier. I was a little confused in this
station & the was not nice & his cries after telling him the news seemed so fake..🙄

10. Bbn- - stroke - palliative care

I don't know if I'll call it a breaking bad news cos GMC tweaked it a bit. She already knows about her father's condition.
She talks a lot, She's pregnant, says father is a very nive person, mother died of cancer, husband is not around.
Show plenty empathy, plenty, don't rush!
Concerns:
Will you send him to ITU?
Can you prolong his life? Why? To see her baby after delivery

11. Mesothelioma-
Man talks a lot, nice man too.
Came with c/o of cough for 9months
Said his soon came in from Tanzanian 2 months or so ago & was also cough, just to confuse you. No night sweats or fever.
No phlegm too I think. Told me without asking that he worked in a factory without adequate protecnon. Currently
working as a carpenter. Talks a lot. He gave lots of informanon if you're nice & show good IPS I think. When I summarised
all +ves told him best/worst case scenario about possibility of cancer (I didn't say mesothelioma🤦 ) He surprisingly said
he suspected so & that he wants to get over with it already & asked what next (I was expecnng a depressed look). Urgent
referral to respiratory specialist. He thanked me..🤷

12. BPPV
Same old story, dizziness (feels like room spinning) had 3-4 short episodes on different days & hx of flu like symptoms
(wanted to confuse us about vestibular neuritis🤔 ). Make sure you rule out every other thing.
Don't forget to mention dix halpike. It's part of the examination paper he will give. Learn how to explain BPPV, I messed
up there.😣

13. Knee replacement post discharge care

Nice lady. Took history, doesn't have anyone at home after surgery (has friends and neighbours but not too close to
them). Told her about social services & occupational therapist to make changes at home, she said that's fine, no
problem.
Concerns: What are the complications? ( I said all & forgot about PE, I don't if I should say she helped me remember, she
asked about PE next, i told her ehat we'll do to prevent it & also manage it.
When can she resume daily acnvines (I think she's a gardener) Told her I'm not sure but will find out from my consultant
just to be sure. She said okay fine. Forgopen the last concern. There was snll nme, I asked if any other concern, said she
can't think of anything at the moment & that do I have anything else I think she might need to know? I was thinking 🤷
So I told her about things not to do immediately after the OP.

14. Htn - Amlodipine

A hypertensive that came with c/o bilateral ankle edema, recently started on amlodipine. Ruled out HF & others. Works
as a dog breeder or something so it's been affecnng her job & daily acnvines. Mennon that you examine legs & listen to
chest & nerves all over body🤷 So it's a medicanon side effect. Tell that you'll change medicanon aqer confirmanon with
seniors. She'll probably not ask but I stupidly mennoned Losartan😣 Concerns: Side effects of new medicanon
What else can I do to manage my htn? (Lifestyle advices altheshe doesn't smoke or drink so praise her for that)

15. Raised Alt

Can't remember the results exactly but Ast & Alt deranged. Every other thing fine.
Ruled out every other thing, only alcohol was positive.
Did CAGE for alcohol & she said she feels guilty somenmes & also fights with her husband due to him crincising her
drinking habit. I told her that alcohol intake her affected her liver (didn't mennon alcoholic liver disease cos no nme to
start explaining 🤷 ). Best treatment will be to stop drinking to prevent further damage, referred to Gastro for further
tests to get clearer picture of the situanon & also alcohol cessanon clinic.

16. Meningitis prophylaxis

Same old. Niece in hospital with meningitis. Met niece 2 months ago. Her sister also with niece. Make sure you show
empathy for niece & sister. Don't forget up to date with jabs.
Also very important to keep reassuring her until she gets tired of your reassurances lol.
Red flag about meningitis symptoms. Encourage her to come to clinic for check up!
Concerns:
Will you give me antibiotics
When can I go back to work
One more, can't remember

April 15th stations

Measles
Haematuria - bph - cystoscopy
Vestibular neuritis
Urine dipstick teaching
Heroin wanting to quit
Confusion-sepsis-angela
Mole
Primary nocturnal enuresis
Ankle sprain sick note change
HF abdominal exam ascites stopped furosemide-still smoking-doesn't want to take furosemide again
Pyloric stenosis
Hypoglycemia simman
Contraceptives
PMR- steroid side effects
Covid policy
Unlabelled blood samples - angry pt

16 April

Abdominal pain - Renal colic

DUB post hysterectomy simman
Tantrum child T
PMS - mood swings T
Chlamydia eye infection T
Learning difficulty insulin
ECG teaching
Pap smear lesbian counselling
Suspected bowel CA
Blood culture
Testosterone nose bleed
Catheterization
Mum with lung CA -angry son T
Chest pain - shingles T
Migraine T
Stroke T

17 April

Simman - dizzy spell

Otoscopy
Blood sampling
Depression
Tiredness- OSA
Hypoglycemia
Dermoid cyst
BBN ICH
COPD low salt
ARMD
Sick note
TIA
Autism
CFS
Mother Dementia
Sigmoidoscopy

18, 19 OFF

20 April

1)Gender Dysphoria
2)Hair line fracture
3)abdominal distension for 6weeks in a man. Alcoholic liver disease. Examine the abdomen
4)chronic glaucoma
5)lymphoma
6)syphilis
7)tiredness in oldman.. Copd
8)pcm overdose.. Venopuncture
9)headache..severe migraine
10)chest pain..MI
11)simman.. Cardiac failure
12)palliative care... Dementia
13)cystic fibrosis
14)tiredness... Mild depression
15)head injury in a child.. Mild head injury wants xray
16)worry about medication change. Mother had dose of levothyroxine reduced and she is annoyed nobody notified her.

21 April

Antenatal breech
Dizzy spell/Glaucoma
Testicular exam
Asthma simman
Ecg teaching
Pmr steroid/ cataract
Heroin addiction quit
bbn husband ich
Autism
Adult Measles
Bsc/ssc
Epilepsy
Syphilis
Fb post colleagues