Uraemia & Hyponatraemia

You are F2 in A&E. Patient aged, 82 admitted to the hospital because of new
problem. He is confused now. Talk to his daughter and discuss management plan
with her and address her concerns. There are some blood tests inside the cubicle.

Results:

Hb- 122*

WBC- Normal

Na- 115

Urea- raised

Creatinine- raised
The Sepsis Six

1. Give high-flow oxygen via non-rebreathe bag

2. Take blood cultures and consider source control

3. Give IV antibiotics according to local protocol

4. Start IV fluid resuscitation Hartmann's or equivalent

5. Check lactate

6. Monitor hourly urine output consider catheterisation

within one hour

...plus Critical Care support

8. ELDERLY MAN WITH UTI AND SEPTIC SHOCK

Elderly man with UTI — now presented with septic shock

An elderly man was treated for UTI 3 days ago with

Trimethoprim. Culture has shown E.Coli sensitive to
Trimethoprim. His wife brought him back today. Talk to her.

Husband and wife both are inside the cubicle.

Talk to husband first — "How are you?" — he is confused and

may say,

Who am l?"

Then talk to his wife.

124. TALKING TO CARE HOME - SEPTIC ELDERLY
WOMAN
You are the FY2 doctor in the A&E department. 88 year old lady, Mrs
Olive Green was referred from a care home to the hospital. She is in the
A&E department.

There is no referral note from the care home.

She is confused and agitated. She did not allow you to examine her.

Her Pulse is — 1 20, BP — 90/60, Oxygen saturation is 88%,

Temperature is 38 C.

Talk to the care home over the telephone and take her details and then
talk to theexaminer about her further management.
9. CONFUSION IN AN ELDERLY MAN
An 82 year old man was brought to hospital with sudden onset
of confusion.

Talk to his daughter and discuss the management plan with her.

Blood tests are done and the results are kept inside cubicle.
UTI BPH

You are F2 in GP.

Mr.Arthur aged 75 presented to the hospital with dysuria.

Please talk to the patient, take history, do relevant examination

and discuss about your initial plan of management with the
patient.
UTI FEMALE:
You are F2 in GR

Janet aged, 27 has presented to the clinic with abdominal discomfort.

Please talk to the patient, take history, assess the patient, discuss about
management and address patients concerns.

Please write for her a complete prescription of appropriate medication.

LOIN PAIN:
You are F2 in A&E.

Mr. Patterson aged 27 years, presented to hospital with loin pain.

The patient was given Diclofenac by nurse.

Please talk to the patient, take history, assess the patient and discuss
management with the patient.
HAEMATURIA:
You are F2 in GP.

Mr. Zimmerman, aged 57, presented to the clinic with haematuria.

Please take history, assess the patient and discuss management plan
with the patient.
Analgesic Nephropathy
You are an F2 in GP. James Anderson aged, 30 came to the clinic with a
new problem. His eGFR low and Creatinine is High. Please talk to the
patient, discuss plan of management

with the patient and address his concerns.

BREAST
Nipple Discharge
You are an FY2 in GP. Yara White, aged 29, has come to you
because of Nipple Discharge.

Talk to her and address her concerns.

BREAST EXAMINATION:
You are F2 in GP.

Mrs. Selina Gomez aged, 44 years, presented to the GP. She is

concerned because she found a lump in her breast.

Please talk to the patient, take focused history, do relevant

examination, discuss about management with the patient and
address her concerns
95. CYCLICAL MASTALGIA
You are a FY2 in GP clinic. A 28 years old lady come for
lumpiness and pain in her breasts. Take history, do relevant
examination and address her concern.