2/4/2011—Brisbane

O&G
Station 20

Station 5 GP setting: Young female around 30 years old complains about urinary problem and she has history of two vaginal deliveries. Tasks: Take history Ask for physical examination findings Manage your patient

This is a modified AMC book case 128. The differences were she only had features of stress incontinence, denied smoking, had history of constipation. She was on POP but otherwise healthy. I did P/E per book case and there was no prolapse. Then I recommended life style management first including pelvic floor exercise, wt reduction and constipation management. The role player asked about medication and surgery. I told her that some medication such as oxybutynin could help for those who had urge incontinence but not for her. Surgery was not recommended for her at this stage.

AMC feedback: Urinary incontinence (passed)

Station 11 GP setting: middle aged female patient has been trying to conceive for last 12 months but no success. Your task is to counsel the patient. This was an old recall of female infertility. The patient had infrequent sex 12 per month and no history of STDs. Although infertility was more likely due to infrequent sex, you still need to know about all the investigations. The role player asked about investigations for the examiner.

AMC feedback: Primary infertility: unknown cause (passed)

PAEDIATRICS
Station 2 GP setting: father brought his 5 yr old boy due to excessive thirst and frequent urination. BGL is very high (30). Tasks: Explain to the father your diagnosis Short and long-term management This was a combination of f DKA and book case 20 (Refer to old recalls). The role player asked lots of questions which require good understanding of DKA (Study Dr. Wenzel’s note well).

AMC feedback: Newly diagnosed child diabetes mellitus (passed)

Station 10

Station 16 GP setting: 5 weeks old baby is brought in by his mother due to refusing feeding and SOB. Tasks: Take history Ask physical examination finding Manage the patient

HOCP: Mother said her baby was not feeding well for last week and got worse today. He refused feeding and had difficulty breathing today. Denied cough, fever, rash and diarrhoea, but had no urine output today.

System R/V: He’s never been sick prior to this. BIND questions: Pregnancy was uneventful and mother had home delivery which was nature vaginal delivery by a midwife. All of the antenatal checkups were normal. No concern has been raised regarding development. P/E (You need to ask specific signs, otherwise the examiner will ask you what are you looking for.) GA: sick looking baby, well perfused, nil signs of dehydration, no cyanosis. VS: RR is 70/min, PR is regular. Sorry I can’t remember the rest or maybe they were not significant. ENT: NAD CVS: heart murmur can be heard but can’t tell whether it is systolic or diastolic. RS: Bilateral basal crackles Abdo: NAD Lower limbs: no oedema. Then the mother asked me what I think of her baby. I told her that I highly suspected her baby had pulmonary oedema due to possible heart failure. I mentioned urgent transfer to ED and further investigation Echo to confirm the diagnosis. The possibility of VSD had been discussed with her and her baby might need surgical repairing for that. Reassurance had been given to the mum that the result of surgery was good.

AMC feedback: respiratory distress (passed)

Psychiatry
Station 7

Station 19

Surgery

GP setting: A patient came back to for US result : aortic artery is 5. palpitation. She mobilised after the operation. which were getting worse. Now complains of SOB. S/A/D: Nil P/E: GA: patient is in distress. She had heparin for 2 days post-op and fluid intake is 3 L in last 24 hours. Your patient is 55 years old female who is day 5 post-hip replacement. Tasks: Take history Ask for physical examination findings from the examiner Order investigations Diagnosis and DDx Hx: She complained of SOB for one hour and there was also chest tightness.5. T 37. VS: BP: 100/60.3 cm in diameter and he is planning for a trip for 4 weeks Tasks: Explain the result Manage the patient This is a straightforward case of AAA. sweating.You are a resident on a surgical ward.1. Please refer to previous recalls. System R/V: not significant PMHx: arthritis Not on medication or allergic to anything. cuff pain. AMC feedback: Abdominal aortic aneurysm (passed) 2. dizziness. Denied cough. Pulse regular and the rest are unremarkable .

ESR. I told the examiner that I highly suspected PE and I didn’t have time to mention my ddx. I mentioned neurological examination but the examiner told me there was no need to perform it. I did the examination per Talley O’Connor. CXY. the examiner handed to me the ECG which was not significant. U&E. GP setting: A male patient c/o leg pain after walking about 200 meters and he is on ACEI for his HT. He is a heavy smoker as well. I couldn’t feel popliteal pulses and Burger test was positive. who appeared in our recall from Brisbane for last May. AMC feedback: Leg cramps on exercise (passed) Medicine . Tasks: Perform the lower limb examination on the patient Manage the patient This was a repeated case of PVD and the role player was a real patient. blood culture. which I think the examiner got it from my history taking and investigations. Ddimmer ECG. I wasn’t entirely sure about the examination findings and I didn’t have time to tell the patient to start low dose Aspirin.CVS/RS/ABDO/Lower limb: NAD Wound/ IV site: Nil sign of infection Urinalysis: NAD Investigations: FBE. AMC feedback: Chest pain and dyspnoea (acute) (passed) 3. CRP. CTPA or VQ scan Once I mentioned ECG. cardiac enzymes.

AMC feedback: Hyperlipidemia (passed) 2. Tasks: Explain the result Manage the patient This was a repeated case. AMC feedback: Shortness of breath (passed) 3. Please refer previous recalls. Her father has cardiac problems and mother has DM.2. If the second blood test in 6-week time was still high. Refer this case to book case 65. Tasks: . GP setting: middle aged female patient was diagnosed Essential HT by your colleague and treated with ACEI.GP setting: 35 yr old female patient comes to see you for blood result.GP setting: 55 years old female patient c/o SOB ( this is the shortest stem in my exam) Tasks: Take history Ask for examination finding Manage the patient This is a repeated case of pleural effusion DDx case. medication would need to be added. After explaining the result.1. I advised her regarding life style management and f/u in 6 weeks.5 HDL 1. AMC feedback: Acute myocardial infarction (passed) 4. A list of blood result was given: Chol 7. She stopped the medication herself and today her BP is 160/100. BGL Normal and the rest can’t be remembered. ED setting: Male patient c/o indigestion which turned out to be chest pain.

I found a MIMS on the table next to me and asked whether I could use it. I really had doubt at that time. At the beginning. I tried to clarify to the examiner whether the secondary causes of HT were excluded or not. She said she stopped for 6 months due to running out of prescriptions. but the examiner said all the information were given and she couldn’t provide anything more. Tasks: Take history and management This was a case I studied a long time ago. The problem was that I still had some time left and the examiner asked me the name of the medication. I also asked the patient whether she had tried life style management before starting medication. AMC feedback: Acne vulgaris (failed) . but I failed this case. I talked about skin care and offered medication for 3-6 months. This case might appear simple but I think there could be traps. The examiner was nice and allowed me to use it. There are two pictures hanging next to the stem which are from MCQ book.Explain the complication of HT Manage the patient This was a new and strange case. but I chose to trust my colleague’s previous diagnosis. I know the diagnosis was acne vulgaris when I saw the pictures. but I couldn’t remember the name of medication for it. Then I talked about all the complications of HT and told her to continue the medication. GP setting: 17 years old male comes to see you due to skin rashes. Please refer other people’s recalls. My mind was blank and I told him that I couldn’t remember the name. But I couldn’t find the name of the medication before the bell rang. The role player asked me whether the medication was effective and I gave him a positive answer. I got the conclusion that the patient didn’t take HT seriously. AMC feedback: Non-compliance with anti-hypertensives (failed) 5. After taking history. Also her BP had to be monitored frequently and she told me that she could monitor it at her work place. At this point. She seemed satisfied with my answer. I asked the patient why she stopped the medication. She said no.

AMC feedback: Gallstones or Peptic ulcer PASS 2. Take focused history. 26th February 2011 Adelaide 1. relieved by glass of milk. I would like to thank my VMPF bridging long course tutors and particularly Dr Wenzel. so I’ve mentioned that he’ll need r/v by gastroenterologist. About the pain. will have to stop taking Nurofen. This was real pt and did not have dorsalis pedis pulses on one leg PHx: T2DM . As he was persisting on the gallstones issue I tried to draw a picture and explain where they are and that number of people have them and are completely asymptomatic and most of the time are not cause of any problems. guess it’s a good thing to do. or bloating. My Dg was peptic ulcer or gastritis and I based any further Ix around this Dg. Middle aged male pt. It is nearly impossible for me to pass the exam without the support from my family and friends. upper abdo. whom I have known for nearly four years. explain you Dg to the patient and organise further investigations. I would like to thank everyone who helped and encouraged me during my exam preparation. usually fit and healthy FHx: nothing significant Meds: no regular meds but has been taking Nurofen lately because he hurt his back when trying to lift something and was given Nurofen by some other Dr. Apparently he had a friend who has his gall bladder removed and this prompted him to go and have his gall bladder checked and was told that he has gall stones. he will also need gastroscopy. The bell rang as I was half way through. Some other candidates mentioned PPI.I could have done so much better when I think back but I am very happy about the result because in the exam my performance was not 100%. I didn’t because Mx was not in the task. or jaundice …or any symptoms that might have suggested gall stones. When I’ve started taking history the patient’s first complaint was that he has some unspecific upper abdominal pain and he thinks is because he has gallstones.unspecific. He is such an unbelievable doctor who has done so much for IMGs and set an excellent example for all of us. 56 y old gentlemen come to your GP for a consultation and advice. comes for foot examination and further advice/management. PHx: nothing specific. On further questioning – he never had abdo pain or discomfort.

I suggested short stay in ED. so didn’t eat her breakfast or drink much before the start. no focal neurology. FBE. nothing specific in home. He will also ask about work arrangement. ophthalmology and nephrology r/v. not sure if this is right or wrong. the examiner will rush you through the examination just so you could have more time to counsel the patient and suggest further investigations and management. Think this was a counselling station where we were expected to tell him that he probably has Pneumocistis carini chest infection (if you don’t mention the pathogen he will specifically ask for it). When you ask the examiner for findings he’ll say BP 110/80 and 90/60. My Dg was just a simple reaction to stress. Young patient who is known to be HIV positive comes to your GP with a complaint of severe cold like symptoms and cough for the past few days. Some of the other candidates mentioned HOCM. no issues. I didn’t as it looked to me as a simple vaso-vagal reaction. Mother will also mention that she was very anxious about the run. On questioning he will tell you that he is HIV positive for the past 5y but hasn’t had his CD4 checked for several years as has been feeling well. 12 year old girl run the school marathon and fainted once she finished.5. Take history. ask for findings and answer questions. She did prepare for the marathon but usually eats healthy and whatever mother prepares. I personally think that my physical examination was very poor but guess I did well on the management part. No harm in doing that AMC feedback: Adolescent vasovagal syncope PASS . IV fluids. he also needs a referral for an infectologist for proper assessment of AIDS and start of antivirals.It is the diabetic foot examination station. everything will be provided. sudden death ect. have ECG. you are actually talking to the mother who is worried and wants’ someone to explain what is the cause and what is the further management. having said that I never asked about family history of heart problems. I also mentioned that he needs to have blood test done to check CD4 count and assess progress. he told me that he has been like that for a few days. has other siblings. overtiredness resulting in a postural drop. no heart issues. LFT. UE. HR 78 afebrile. Now in ED. normal delivery and development. but was really good. should he tell his employer…… AMC feedback: Fever in immuno-compromised patient PASS 4. The main point is to ask when was he last seen by endo/physician and request HbA1c. give her something to eat and drink as BSL was borderline. BSL 3. AMC feedback: Type 2 diabetes mellitus PASS 3. check bloods and will r/v in 1-2 hours. and has stoped working (works as a chef in a restaurant). not obsessing about diet…… When asked about the collapse she said once the girl finished she set down on the ground to rest and collapsed when tried to get up. all fit and healthy. When you start asking questions the mother will tell you that she is perfectly fit and healthy. The role player was coughing the whole time.

Explained that it’s due to the diabetes as well as the previous DVT. but maybe because I did refer to hospital and mentioned US??? 7.changes in the kidneys. but the main points are: . There will be hips of questions. Also mentioned that in ED they might decide to do an US. noncramping. Young female. When asked for findings told – as you can see on the picture. My mistake – I forgot to ask for vaginal examination (exclude ectopic). On history taking – she’s being felling well up until yesterday. On palpation abdomen is soft. 10 weeks pregnant comes to your GP practice complaining of abdominal pain and vomiting. ask examiner for findings. dull. than I asked if there were any pulses – yes. likely pyelonephritis. blood and leucocytes. She looks flushed and feels sick. explained what it is. will take long to heal and the best management is to prevent infection. The pt is a 40 something female who scored poorly on concentration and recall. Will do one now and will organise district nurse to visit regularly at home. Take focused history. On history taking she has T2DM and had DVT on the same leg wile ago. pregnancy was spontaneous. The examiner tried to prompt me and asked is that all you need to know????? My response – looks like upper UTI. Take focused history. HR 80. Again the pt tried to prompt me by asking what will they look for on the US? My stupid response. on MCU proteins. have good circulation and do regular dressings. a med student has just done an MMSE 17/30 and wants’ to talk about the results. she also has pain in her left loin and had burning and stinging sensation when passing urine. ask for findings and suggest further management. it’s not healing and she thinks it’s getting even worse. Picture on the wall of venous ulcer. On findings – febrile. for how long??? AMC feedback: abdominal pain in early pregnancy PASS Still surprised how I passed because in my view not excluding ectopic is a critical error. expected.5. what antibiotics will I need. signs of hydronephrosis…. tenderness in lower abdo and loins. take swab and regular dressings. any discharge – yes. office pregnancy test positive. My advice antibiotics. answer questions and organise further management. You are the HMO on the ward. no issues until now or nausea. Questions form pt – will the antibiotics hurt my baby. AMC feedback: Chronic leg ulcer PASS 6.. The pt is a middle aged female who comes to your GP as she has this annoying ulcer on her leg for few weeks. The pain is in the lower abdomen unspecific. that she needs to be admitted for urine cultures and IV antibiotics for a 1-2 days and than changed to orals. I asked if she is allergic to anything and gave her the possible treatment options. bowel sounds present. She hurt her self while gardening.

depression – don’t care. treatment with Clarithromycin for 7 days. comes to your GP because she found a breast lump in her left breast.Can’t establish Dg solely on MMSE. name as many objects/animal in 1min. On history she only found it. AMC feedback: Teaching a Folstein MMSE PASS\ 8. Ask history and answer questions. non tender. ask for findings. all in AMC book). make sure is not vomiting. not fluctuating. risk of aspiration. think it was 25. advice further management and answer pt’s questions. she just found out the baby is in breech presentation. Basically have to advice FNAB and US because she is only 25. she’s otherwise fit and healthy not on medications. she is quite anxious as her mother had breast cancer. the three types of presentation and the options available is (trial of vaginal if legs fully extended or fully flexed. will probably need to repeat it. Straight forward station. not red or inflamed…. Can’t remember more from the stem but is a typical Pertussis station. 32 weeks pregnant female comes for an antenatal check-up. or caesarean if footling). Questions – what is it?. On examination there is a 1cm lump that is mobile. he actually greeted me infront of the door and said this is an easy one.. who looks after child. other child vaccinated and will probably have only mild symptoms. advice on risks because of family history and explain further management (yearly checks. explain and answer questions. same for family. AMC feedback: Breast lump (fibroadenoma) PASS 10. she has another child (vaginal delivery). stop when coughing. changes day or night. is the child playful and cheery when not coughing. is he in child care.? Also make sure you advice about feeds. is he eating and drinking…. only a screening test for cognitive impairment. . Father of a 1. not painful it’s on the external upper quadrant. How did he get it? How will you diagnose/know for sure? How do we treat it? What about us and our 4y old? Can we go and visit friends? For how long do you treat? Make sure you ask what the cough looks like. delirium – pore score on orientation. dementia – frustrated if they can’t concentrate and answer properly. Young female. similarities and differences. I actually said 7-14. AMC feedback: Pertussis PASS 9. She doesn’t know much about breech so have to explain what it is.5y old child comes to you because his son is coughing for more than 10 days. better if not visiting for a while because he is contagious…. if suspecting frontal lobe/vascular dementia add more tests (motor repetition. she said everything was OK so far (must ask about all antenatal screening/visits/test). Talk to the pt. self examination every 2-3 months and mammography after she is 40). Take focused history. Typical breast lump question and the examiner was really nice.

always ask for bowel motion. ASOT. Take focused history. but the main think is that you should avoid giving him a referral and suggest psych r/v. On history taking – he is usually fit and healthy. Not much I can tell – on history try to exclude psych issues. menopause. Middle aged female comes to your GP because she has problems with the “nerves”. blood FBE. and according to the numbers it was supposed to be a peads station. AMC feedback: Body dimorphic and social anxiety disorder PASS 13. maybe trauma. young man comes to your GP because he wants a referral for plastis because he thinks that his nose is too big and is the reason why he can’t progress in life. This was a really confusing station. Typical thyrotoxicosis/hyperthyroidism station. but he feels that his face is a bit puffed. some sort of nephropathy. advice further management and answer questions. 35 y old male comes to you GP with a macroscopic haematuria. The funniest thing about this station was that the role player actually did have big nose Anyway. He wanted to know what is it and I did my best to explain PSGM. sweating. US. C3. Maybe you should also have a look at other recalls. AMC feedback: Haematuria PASS Pls note that one of the other candidates said that the pt told him this was his second presentation and he felt it was IgA nephropathy. ask examiner for findings and advice further management. maybe antibiotics depending on swap and blood results. (There was an observer in the room and they kinda nodded to each other and smiled ) AMC feedback: Breech presentation PASS 11. I started by asking her does she have any preferences about the delivery and think the examiner quite liked that. weather . have a read there. no pain just blood in his urine. culture. He had sore throat for couple of days. check MCS. no fever. U&E. this happened all of a sudden. strict fluid balance. Funny station because he actually took a small mirror from his pocket and was trying to explain what is wrong with his nose.There is always a risk of slow progress with vaginal trial so must be psychologically prepared that may need CS eventually. Told him that although macroscopic hameaturia is unusual for PSGM he still needs admission for full investigation. 12. C4. family meeting…. My differentials were PSGM.. throat swap. stone. ask examiner for findings. Take focused history. There is also the possibility of external rotation latter in pregnancy…. first because it looked like PSGM but it was an older pt. the examiner asked me to summarise what investigations I want once admitted. this is question from the AMC book. Psych station. still soar but didn’t see anyone about it. BP control. He also had a sore throat few days ago. I was leaning towards PSGM so focused all my further instructions in that directions.

but generally OK. advice and answer question. I was so confused and uncomfortable. than she asked what kind of an infection. I thought it was Celiac disease and focused my further Mx in that direction. Now looking backwards think I should have given her more time to absorb all info and ask if she has questions. The only thing I knew was that it’s a rod inserted on the inside of the nondominant arm and lasts for 3y. usually healthy. 18 y old girl comes to your GP because she wants Implanon. no trauma…. AMC feedback: Infant with poor weight gain PASS 15. Take history. no CXR. palpitations. weight gain/loss. infection. AMC feedback: Nervousness PASS 14. Told her that he needs an assessment by peads. everything else is normal (no bloods. all of a sudden he become confused. but if not managed can lead to serious complications. Really weird station. Take history. Again not much I can say as I failed this station as well. started solids from age of 4 months. bloods. At the end I asked if she has any questions and she said it’s too much to digest. she says that he is a bit agitated sometimes. instead I just kept talking for few minutes. T 38. she wants’ to know if her son is progressing as he should. if you ask milestones they are OK for the age. However I didn’t mention encephalitis AMC feedback: Encephalitis FAIL Please note the candidates who did mention encephalitis were asked how he might have gotten it? 16. or if anything is unclear. but latter there is a progressive decline. When you actually do the chart will realise that up till 3 month right in the middle for weight. eating and drinking. draw growth chart and discuss any issues/answer questions. On history the child is fine. TFT explain that will most likely need meds for a prolonged period of time…. Tried to explain what CD is and why I suspect this is the case and how we make the Dg. he eats everything including bread.) My differentials were trauma. Findings HR90. so when the role . delirium. non drinker. When asked about his food and any diarrhoea. only 10%o. I also explained that it meant he has a life long condition that can be easily managed by diet. FBE. he does have few loose bowel motions every day but she copes well with that and thinks he’s not distressed by that. toast. give differentials and explain questions. now he is incomprehensible and you are supposed to take history from his wife. chest. no CTB…. and now on 9 months he is on the lowest border. cereals.intolerance. Middle aged pt is admitted to ED with confusion for more than 12h. On history nothing much. don’t talk about Ix or Mx. UE. not much I can tell because I failed this one. appetite. ask for findings. These were the most dreadful 8 minutes in my life as I knew I will fail even before I entered. maybe even a UTI presenting as delirium. ask for family history of autoimmune conditions… Mx check ECG. I did mention acute brain sy. ect. I knew nothing about Implanon. he will need specific antibody tests and if positive will need special diet. Mother of a 9 months old baby comes to you for a regular check up. meningitis.

when I tried to outline what I will focus when doing physical examination I only reminded . I passed 14/16. I actually made some mistakes and missed some important things on examination. did not get much time off from work so had to use my annual leave. Dg and further Ix and Mx think I still passed some stations if you can’t find a study group don’t stress. Outside the room. Wenzel’s classes are also wonderful. I only used Mourtagh and Oxford and think it’s more than enough. . or will forget something.player asked me if she can have it done today I forgot even what I knew – that it’s a surg procedure and she’ll need to be booked in. However always try to speak out loud. This is my 2nd station ( my 1st station is Rest station!). I only studied actively for 1 month. . so couldn’t really fit with a study group). AMC feedback: Implanon counselling FAIL My advice – read everything there is about OCP and HRT because you WILL get a question about one of the two So there it is. think it’s always better to prompt candidates to actually look for more. A 52 yo man who has smoked 20 ( or 10) cig/day for 20 years. 1.Summarise the case to the examiner. I’ve been through the AMC book and the recalls 2008-2010. not just memorise recalls. come for check up because of chesty cough. I had to study alone ( have a 2y old boy and had to run back from work. I did try to study around the topics a bit. Nevertheless if you have a chance go to at least few. but maybe because I was confident in my differentials. quite happy with the outcome. Few tips: don’t just read recalls. than there was always something on the weekend. I’ve only been to 3 but found them to be really useful - - All the best CLINICAL EXAMINATION – MELBOURNE 19TH MARCH 2011. You are in GP clinic. unfortunately a bit difficult to attend to if you are working. broaden your knowledge by reading a bit more because topics are the same but questions wary slightly be confident. when you just go through the questions in your mind you’re not practising and will most definitely be short in time.Perform respiratory examination. That’s why I was a bit “stingy” with this recall.

. The examiner suddenly asked me to wash my hands.. I entered the room.. c/o headache which started this morning. And I totally forgot COPD. The examiner said: no. The Pt is a young man lying on the bed.myself: don't forget signs of Lung cancer ( Horner's syndrome. But when I came into the room. migraine. 2. I asked him to repeat. Pancoast syndrome's signs the examiner rushed me to check PFM. I checked vocal resonance with a stethoscope! Fortunately I realised it was wrong so I checked it again with hands. AMC feed back: respiratory examination. No specific type or location. By mistake.. Anyway I still washed my hands and the bell rang. No other symptoms. At the end. No neck pain. This pain is different from the previous ones. I was so panic and wondered if i missed anything. In a hurry. no head injury. he's OK. suddenly I changed my mind: is it SAH? I greeted the Pt then asked if he needs pain relief.Give provisional diagnosis. when I was mentioning Horner syndrome' signs. . "PAIN" questions: Pain 3-4/10. I thought maybe it is tension headache. I made a quick glance to the Pt and try to guess if this was a real Pt (but I could not).Take relevant. He did it wrongly.Find out PE from examiner who only gives you the clinical findings which you're asking for.Mx. After greeting the examiner and the Pt. asked the Pt to do PFM. 3-4 times last year. . Time almost ran out. Past Hx of migraine. focus Hx. A 24 yo student comes to your clinic. I connected the mouth piece to the device. Outside the room.). No Hx of contact. hand examination for nerve root compression. CT scan. no stress related. . . I ran the commentary quickly and ordered some Ix: chest X ray.. ... There are no abnormal signs on PE but nicotine stain on right fingers.

The mother was also asthmatic but has settled now. 4 yo girl was discharged from hospital 3 days ago after an asthma attack. at that time I was so confused and could not trust my memory ( !) although before the exam I tried to memorise asthma action plan. She is fine now but mother wants to know about asthma action plan. I mentioned about notifiable disease and prophylactic ABT for close contact. T 37. I explained about reliever. preventor . . UNWELL. BP normal..... When I asked for Koernig.Discuss about the girl's condition.5. The examiner smiled and asked me who is close contact. She replied: all is OK. .. Provisional Dx: Meningitis maybe due to Meningococcus. medication. I turned to the Pt: whom do you live with? Girlfriend! Then I said his girlfriend needs Rifampicin for prophylaxis.. Trigger factors. Then examiner asked me to go out.. He was not allergic to PNG so I gave him PNG. 3. I asked if she gave the medication via spacer or puffer and if she know . I said if I can ask her some Qs. Then I asked Hx of asthma of her daughter: when Dx... I told the Pt he needs to admit to hospital for further Ix and management.PE: No rash. how she goes with the medication. With the asthma action plan in hand.Future Mx.. I started to expl what asthma is ( draw the pic). Neck stiffness +.. the examiner looked happy. She comes to ask about it at your clinic. When I entered the room I saw asthma action plan on the table.. To be honest. Babinski signs. Fa Hx. I asked if he had any concerns he said no. I said this is symptom based plan the stared from WELL. AMC feed back: Acute headache. HI.When I finished I asked if she can follow me she replied so far it's OK. The mother asked me: which medication? I said the tablets (I means the corticosteroids orally). Then I said at this stage your daughter only needs reliever medication (because she has only 2 attacks in the last 6 months). FO: not available... Explain Asthma action plan. how she is now. I asked the mother about her daughter's condition. Bruzinski. I was very happy and I grabbed it. how frequent.

Bell rang when I just finished. When I read the senario. AMC feed back: Chronic asthma. i was so nervous whether it is 2 symptoms of 1 disease or 2 different diseases. Thomas test -ve.Take Hx. Finally I reminded the mother to avoid trigger factors and to realise red flag symptoms. 4. Recently she has groin pain. No tenderness on tenderness along the spine. the examiner said it's not available. When I was ordering for Ix: X ray. If it is OA? but why OA has the symptoms like intermittent claudication. No other symptoms. Examiner asked what Thomas test means – check fixed flexion deformity of the hip for ex in OA. She said no. I was panic because I could not reach to the Dx. No lump in groin. no abnormal sensations. A 64 yo lady coming to your clinic c/o lower back pain. NOF fracture). Then I asked for Burger test. Suddenly bell rang and I had to enter the room. Doppler US. She said: spacer but not sure how to use. Then she smiled. The Pt was sitting on the chair.Give Dx. No other medical condition. She ask how about her daughter's condition in the future? I said she may grow out of asthma as your case. She was Dx with chronic lower back pain for years. I asked if she need pain relief. Settle in few minutes after she stop walking. Trenderlenburg +ve (so it could be : OA. No calf pain. No muscle wasting. PE: Everything was normal.. no swelling.how to use it. Then I said via space is the best way to give reliever at this age and showed her how to use it correctly. . Knee normal. no deformities on right leg. gluteus medius weakness. Appears when she walks for a distance. did not getting worse recently. PAIN Qs: lower back pain for years. If it is sciatica? but the Pt confirmed: no pain at the back of thigh or leg. . the bell rang! . Right groin pain for last 4 days..

During that time. I said yes. She comes today for the result. After assessing carefully we think ECT is the best choice of Tx now. effects.He looked happy. I took a lot of time for Hx as I could not find any cue for Dx. Pt will be under GA. He asked me are you sure she is not in pain.. -Expl ECT. The examiner asked me: if I finish my task then I can go out. But they are temporary. Then the examiner asked me you'd better to go out. She refuses to eat and drink.At the rest station I kept thinking about the case.. Some electrodes will be put on the scalp and electrical current will be used for Tx. don't worry. now your mother is not in a good condition. -Discuss with the son and answer his Qs. indications. I was not sure whether my performance was bad or I missed anything. Pt may have jerking movements. Medical Tx has failed. Then I said about SE: headache. The psychiatrist decided to have ECT for her condition. She wont feel them at all because she is under GA. her health will be deteriorated soon. I finished early. taking medication. I felt so upset about myself. The long Hx of the elderly lady who has been Dx with schizophrenia. They both laughed. I said about indication of ECT. she becomes self neglected. X ray was done and showed crushed fracture at L4. Recently she refuses eating. I understood his feeling then I continued: as your mum has given you a consent so I will talk to you about her condition and Mx plan. forgetfulness. . Bone density -3. Then I replied my task is discuss with the son so I would like to stay here if he wants to ask me more. . dizziness.procedure. I said usually we do not dislodge one's medical condition to others.. My performance was not good. He has been given a consent from his mother. A 70 yo lady c/o back pain. At the time. I could see the relief on the examiner's face! Then I did the case as Dr Wenzel's notes. 5. Then I told him the whole procedure: anaesthetic assessment. Anyway I reassured myself I have a right to fail 1 in 4 stations! :-) AMC feed back: hip pain. Her son comes to your clinical asking for ECT. the examiner looked at me nervously as if I did not understand the task. Firstly. You see. I added if we compare the benefits outweigh the disadvantages. 6. AMC feed back: ECT.

. expl the results. They decided to leave the tumor and did colonostomy.Bone thinning: Needs more Ix to r/o other diseases: RF. 7. any symptoms of menopause. exercise. A elderly man had operation few days ago for bowel obstruction.. She said she OK. liver.. . . lumps in the body..Smoking.Spinal fracture: pain Mx.. rest on firm mattress. night sweat. take diary product. The biopsy post op has confirmed colon carcinoma.Any trauma. diary product.. . .. any complaints. AMC feed back: osteoporosis.Fa Hx. Still sexually active. occupational therapy. Then I asked Hx .Diet: milk.Plan Mx.Exercise. I explained her that there are 2 issues: . multiple myeloma. Then I mentioned about life style modification: stop smoking. The surgeons found that there is a tumour in pelvis and some spreading to mesentery. Answer the Pt's Qs.Malignancy symptoms. healthy diet.. . biphosphonate ( how to use.. weight loss. injury. Pap smear. SE. I did not mention about HRT because her menopause was 20 years ago!.).Menopause: when. . I greeted the Pt then asked if she is in pain.. Give some medication: Vit D.Discuss.... The Pt now comes to your clinic c/o abdominal pain and ask about his condition. mammography. physiotherapy. . . sun expose. hyperparathyroidism. SERM.

PE: T 39. I said your case will be Mx by MDT. My provisional Dx is septic arthritis. injury. swelling. At that point I though it would be a case of breaking bad news.. Not sure about effusion as child did not cooperate. No trauma. FBE. he said no. Crying when touched to right leg. He insisted he wanted to know how long he can live. bone scan. . About the pain. Finally the bell came. knee aspiration for microscope. I wondered if this is breaking bad news or if it is complication post op because the Pt c/o abdominal pain.Outside the room. I turned to the examiner and said for colon cancer at this stage. the oncologist will arrange further Ix: CT scan. Father brings his child to the hospital. Then to the Pt.DDx. . At the small countryside hospital. Then I asked if he comes alone. bone scan to find out where the cancer spread to. if he needs pain relief.Mx. The child was healthy previously. delivery were normal. When I stopped for a while for his relief. No flu like symptoms recently. any other symptoms. Refer the child to the tertiary hospital where the paediatrician will do further Ix. I escaped the room. surprisingly he pushed me to continue. 12 month old child suddenly refuses to stand on his legs when his mother holds him by his sides to support him to stand as usual. the quality of life is more important the quantity of life. blood culture. 5 year survival rate is 25 .. advanced) 8. He asked me how long he can live.. Immunisation up to date.. I was reluctant to say but at that time the examiner told me loudly: how long he can live? I was so panic. Swelling at right knee. AMC feed back: Carcinoma of colon ( recurrent. I said we will try our best to give you a comfortable life and the outcome would be different from person to person. . any redness. there are a lot of options depending on the severity ( I mentioned about step wise of pain Mx in J. be optimistic. However I needs to rule out osteomyelitis.30%. We also start with IV ABT.. I asked the Pt how severe the pain is. Father had no idea about where the pain is. I mean Duke D.. -Ask PE .Take Hx.Murtagh book). All Hx about pregnancy. I said it's too early to say.. culture.

pls bring him to see the doctor. BP). B ( BMI.. BP.. Cholesterol 6. I took a quick glance to the paper task and found that I did mention all the tasks! Why did he look so cold? As I had no more information to talk so I turned to the role player again and asked if he could arrange for his child's admission. chest pain. E ( exercise). . you will. sudden death. Last time he had stress test done which showed ST elevation ( I forgot which leads). the examiner asked me: do you think you have finished your task. About medication: statin would be consider if there is indication as in his case if cholesterol increases up to 6. I asked if he is OK. sometimes we are not able to find out their origin. PAIN Qs. they could come from skin infection. So next time if your child has skin lesion. He said yes. . I replied this is a countryside hospital. His records are: BMI 35. 9. C( smoking). Examiner then asked me: where does the bacteria come from? Well. The role player asked me: are you sure if I follow your advice I will have a healthy life? I nodded my head and said surely. smoking 10 cig/day. Risk factors of CVD Qs: diet. I did not forget the senaerio. Today he comes for the results. He laughed. D ( diet).5. AMC feed back: Septic arthritis. I . Stress.. I don't know why whenever they laugh I become anxious and panic. ABT should be 3 weeks IV when then 1 week orally ( I'm not sure) When I asked the role player if he has other concerns. I said I will arrange NETS ( National Emergency Transport Service) to transfer the child to the tertiary hospital and also social worker will support him if anything in need at home. BP 130/80. he said: do I need an operation? I realised I missed something... Luckily. I'm afraid if we don't have the facilities to follow up the case as many severe complications may happen esp septicaemia and the child is only 12 month old. So I wondered what else he wanted. A 50 yo man. hypercholesterol. Fa Hx of DM. He said he is OK now. body weight. sore throat. Then i expl about the test and its purpose. any chest pain now. He did not look happy..Expl to the Pt his test results. I said about Mx plan based on life style modification: A( alcohol). HT. Hx of DM. throat infection. How long for ABT? Because the child < 5 yo.Examiner asked why do you send the Pt to the hospital? you are in the hospital now. I drew the pic to expl coronary artery's function.Plan Mx.

This is the 1st time she has this condition. 4 yo girl whose parents have separated for last year. swab for evidence and Ix to r/o condition likes: infection. For the last 4 days the mother has noticed rash in her vulva after the child came back for her father's place. I will contact social workers . 10. Talk to the mother about her concerns. Then she continuously told me about her suspicion. Take relevant Hx. I will refer you to a cardiologist he will perform Ix to find out where the blockage is by injection dye. AMC feed back: Angina pectoris. Then I expl to the mother that I suspect this is non accidental injury. Outside the room. blamed her ex. Child stays with father 3 days/week. They smiled and asked me to go out. they will help her as much as they can. No other signs of trauma: bruising.. No financial problem in both sides. asked me to help her to keep the child with her. VS – normal. eczema … which are less likely. After I greeted her.said it's too early to say about op. old fracture. CSA. no vaginal discharge. was healthy. Ask examiner PE. The role player was a Chinese medical student. No bruise. PE from the examiner: Child looks normal. growth and development – normal. I also report the case to CPU. no laceration. The child also refuses to come to her father's place. has no new partner. drink. However I will take the pictures. Rash in vulvar area. prevent the father from doing his custody. no scratched marks. she started sobbing. No specific findings.. Then I ask about the child: the only child. The child will stay in the hospital which is the safest place for her at the moment. She looked really upset. He does not smoke. Then he will decide whether you need op with stent or graft. You can come with her at any time. So I started asking Hx with HEADS Qs. deformities. The mother suspects sexual abuse. I thought this is child abuse but at this point I wondered if this is a case of mental disease ? Depression because her acts were exaggerated.

He smiled and said: good.Take Hx. PAIN Qs: RIF. no Fa Hx of female cancer. Speculum ex: no bleeding. your abdominal pain so most probably you have ectopic pregnancy. Urine dipstick -. a 24 yo female student. no Hx of miscarriage. I told to the Pt due to your last period is abnormal. don't let her come with her father. After greeting the Pt. normal size. Event family court may involve. LNMP 3 weeks ago. It is my responsibility to look after your child's health. I drew the pic and said your chance to have pregnancy is 60%. AMC feed back: Sexual abuse. your pregnancy test +. she is stable.2.Provisional Dx. 5P: not has children yet. no discharge. Os normal. Has no idea about breast US. When the Dx is confirmed there are 2 options of Tx: medical Tx ( I mentioned indication) or surgical Tx. I was confused! Why did she still upset after my explanation? Then I gently touched her hand and said pls calm down and think positive.they will help you if there is anything in need. She said: you're not going to help me to keep the child with me. doesn't know about blood group. I asked the examiner if my Pt is haemodynamically stable. no other symptoms. . no rebound tenderness. . no radiation. She was still upset but the bell rang and I have to go. Uterus: retroverted. psoas. Outcome is very good. . 11. Ddx. In GP clinic. PE: T 37. 3-4/10. Tenderness on RIF. BP 110/60. obtulator signs. I forgot asking about Rosving's signs.Ask examiner PE. The CPU. Again. The mother still looked upset and started to cry. lighter than normal. c/o RIF pain for last few hours. Mc Burney: not clear. We are here to help you. I needs to admit you to hospital where the gynaecologist will do Beta HCG quantity and US to find down the location of the foetus/ sac. Tenderness on RIF and Douglas porch. Pap 6 months ago – normal. close. CSA will try their best to solve the problem. trying to conceive for last 3 months. pregnancy test +. . No past Hx of STD.

any dropped BP – no. inflammation/ rupture of the foot pipe. callous on fingers and most important is electrolyte disturbance. Due to low BSL after Insulin inj.. She skipped the meals because she want to be thinner. with further Ix we can r/o the Ddx. Heart rate – normal. And HEADS Qs: no stress. No anaemia. She said no. She was Dx DM type I at 15 yo and on Insulin. Recently she usually skipped the meals because she thinks she is fatty. She also self induces vomiting and uses laxative to keep good body image. I asked the role player if see know about DM I. we should not eat too much but need to have healthy diet and keep body weight in normal range. Then I asked about her current condition: is she OK now.. Discuss about her condition. AMC feed back: Probable ectopic pregnancy. It's a kind of abnormal behaviour. Then I asks BP. using laxative you may have: dental decay.nothing. I asked if she has other concerns. That's why we give Insulin inj to control BSL. 18 or something lady who was admitted to hospital due to DKA. I exp what it is ( pancreatic gland does not produce enough Insulin …). How is her BMI? He said she is there. do you think eating too much and getting fatty are good for health. PID which are less likely. Apart from that due to self induced vomiting. I forgot to ask about menstruation. if you skipped the meals you may suffer from severe complication. no family conflicts. Any signs of dental decay. you can see. no any specific thing. Turn to the examiner. Don't worry. She said no.The role player asked me if she have appendicitis. ovarian cyst torsion. Your condition is called bulimia nervosa. I smiled with her and said: you are right. well controlled? Check up? Any complications. I finishes early. She looked happy and said pls dont tell my GP! I start with taking short Hx: how is her DM. no epigastric pain. Firstly I assured her about confidentially. I said the DDx are appendicitis. callous on fingers. I will refer you to see the psychologist who will talk to you ( CBT) and the dietitian who will give your a good advice about . I asked if I can ask some PE. Then suddenly she asked me: doctor. 12. Loss of potassium can affect to the heart and cause critical condition.

Then I asked her if she know anything about Down syndrome. When I was asking history. HT. Has not had antenatal check up yet. . The Pt looked really panic now ( I wondered if it is my mistakes to talk about these bad things!) . Not yet taking folic acid. I started by greeting the Pt. No DM. The 21st have 3 instead of 2 chromosomes. . she seemed to be in a rush to know about Down syndrome. clotting disorder.. No difficulty in conceiving. Then I asked if she needs to ask anything. Has symptoms of early pregnancy. no miscarriage. it's congenital abnormalities due to abnormal chromosomes. On the way I went out.. I said it is not hereditary disease. About current pregnancy so far: This is her 1st pregnancy.Take relevant history. She said no but asked if it is hereditary. No Hx of congenital abnormalities except the above newborn baby. bleeding disorder. no vaginal bleeding/ discharge. Here is my card. Finally I said I think there are too many information for you today so I print some hand out for you to read at home. The examination told me: you told her everything. Pap's – normal. No abdominal pain. She looked anxious. HT.healthy diet. Ob & Gyn: no STD. Regular period. No idea a bout blood group. 13. Briefly mentioned about physical abnormalities and consequent complications. You can call me if you have any concerns. A 24 year old lady who is at 10 week of pregnancy came to your clinic to ask about Down syndrome because her cousin just gave birth a Down baby. Hx: Medicine: healthy. Fa Hx: no DM.Counselling her. Then I expl about 23 pairs of chromosomes. However I still tried to ask full Hx. the bell rang AMC feed back: Bulimia nervosa. SLE.

US: nuchal thickness at (11 – 13 week). ALP are liver enzymes. Depends on the type of chromosomal abnormalities: totally or partially ( I wanted to mention about mosaic type. Heart rate – regular. As your Fa Hx. She looked relieved. Then I asked if he feels comfortable. Then I grabbed the copy of the senario. your case will be follow up at high risk clinic. Oestradiol. I said: GGT. ALP. No parotic enlargement. Good things is they are lovable. PE: Pt – alert. No alcoholism. The GP has written a referral to the specialist for further management. when the examiner ashed me to go out.Ask the examiner PE. The increased levels mean there is some damage to the liver cells. So actually. but don't know how to exp them in lay terms) baby may have a mild or severe symptoms. Inhibin A. He said he is OK. She smiled the bell rang. . Also US showed some abnormalities in the liver.Give Dx and discuss with the Pt about further Mx. Diagnostic tests: CVS ( 9 – 11 week. no carput medusa. result in 2 weeks. No jaundice.Exp about the result to the Pt. she said no. .. VS – normal. 2nd trimester: AFF. Finally the choice is yours. miscarriage 1.. A well known case: a 40 something yo man who had pace maker put in few year ago came to GP clinic c/o tiredness. US of abdomen showed some changes of liver ( I forgot).. showed it and expl to him 1 by 1. Chest. Nowadays we have a lot of antenatal screening tests as well diagnostic tests for Down syndrome. I will arrange all the antenatal tests for you plus some screening tests for Down syndrome.2%). suddenly the role player asked: can you tell me the incidence of Down baby in my case? I said: for normal population.I quickly reassured her.5%). result in 2 days. before 35 yo. But I don't know the incidence if the cousin gets Down baby. compliant …. I said I will ask the examiner about PE to see how the disease is going on then continue talking with him. B HCG. no skin discolouration. So I concluded: pls take folic acid right now and continue up to 12 week pregnancy. No confusion ( hepatoencephalopathy). BHCG. .Which Ix would the specialist order? You will only be given the result of which you ask for. Screening test: 1st trimester: PAPA. He said he is tired. there is not a indication for abortion in all cases. amniocentesis ( 14 – 16 week. I greeted the Pt then ask how he is today. miscarriage 0. When I ask her if she has any concerns. heart – normal. LFT has been done : increased GGT. . No spider naevi. Liver enlarged 2 cm below the . She said: if Down baby has confirmed do I need to have abortion? Well Down syndrome is actually not a significant condition. AMC feed back: explanation of fetal abnormality screen. I will ask my seniors. 14. I still have time. incidence of Down syndrome is 1/700.

I drew the pic then explained how sperm and egg meet together. the examiner immediately gave it me. The examiner said: you seem very interesting with this topic. Giving blood 500ml every week meanwhile follow up iron tests. Mx. Counselling. transferrin saturation: increased. ferritin serum – increased. He looked happy but the role player said: I dont know anything. affect to testis. H63D. affect to joint: joint pain. AMC feed back: Abnormal liver function test.. most probably he has the condition called haemochromatosis. Dont worry the gastroenterologist will do biopsy to see if there is nasty growth in your liver. Husband. Due to high level of Fe. it would be a good idea if your sibling. No supraclavical LN. affect to liver: liver cancer which may be a concern in your case.. is happy with their decision. Marital status: happy. Pap. PR: no specific findings. from which sources. The examiner gave me the other paper with : C282Y. General healthy: good. Ix : I asked if I have iron study. TIBC – decreased. no collateral veins..costal margin. except operation for complicated appendicitis with a long scar next to the mid line. They both laughed then the examiner said: you'd better go out. hepatic jugular reflux. affect to pancreas: bronze DM. A 32 yo lady came to your clinic. Not clear. He asked do you know it. 15. Pregnancy … About the pill: what kind. Then he ask me if I think I finished my task. there are many complications which depends on where Fe is going to accommodate. healthy children. wanted to know about sterilisation. any complication. I finished early. Family situation: no family conflicts. I stared: I knew from the notes you want to ask me about sterilisation. Flapping tremor: -ve. When I asked about density: hard or soft. follow up: BP. weight. They have 3 kids ( forgot ages). When the level back to normal. Can I ask you some private Qs before we discuss? She said yes. Then suddenly my memory is switched on. 36 yo. giving blood every 2 – 3 weeks When I asked if he has any concerns he said no. children have a genetic check. Usually it will be done with keyhole surgery but in her case may be .. It is a genetic disease. I said the whole procedure of sterilisation. atrophy. Then I asked: Period. how long. For ex: It can affect to heart – as your case. I asked of she know about sterilisation.. I said because it's genetic disease. I said I'm not sure but my task is to discuss with the Pt so I dont know if he wants to ask me anything. I said they are 2 mutations of gene disorder in haemochomatosis. Then I expl to the Pt. about the border: rough or smooth. Pill. any complaints ( no).

Tx will be long life.:not available.They are critical conditions. Both are fine now. Finally. brain ( stroke).. expl about the role of venous system. The most dangerous is this clot can dislodge and travel to other organs: lung ( PE). I said low molecular. wants to have baby.. Cousin also had DVT.. think carefully if you want more information I will give you hand out. advantages. Take relevant history. I emphasised: successful rate is not 100% due to reconnection. This is the 1st time she has this condition. IUD ( I said about route. Refer to haematologist who will put her on Heparin 1mg BD inj and Warfarin orally. She has 2 relatives diagnosed with DVT. Current condition: no SOB. AMC feed back: request for Sterilisation. no varicose. Order Ix. In general. Examiner asked what kind of Heparin. implants. weight loss. . no pregnancy. no Hx of DVT. needs to have micro operation: successful rate if 60% with hight rate of ectopic. No Hx of other diseases. and no prevention for STD.. coagulation profile. I also mentioned about male sterilisation which is more simple. not on any medication esp female hormone. blood can not get back to the heart.. Mx I asked all risk factors of DVT: no travel by flight. she said no. SLE. or fracture or immobilisation. D dimer. Sister had DVT. Trapping of blood causes pain. ANA.. I said: Minera. Epl: I drew the pic of the leg. Expl to the Pt about Dx. go home. Coagulation profile: INR for follow up Tx.normal abdominal operation as she had previous op. no obesity. Then I said you dont need to be in a hurry. the young lady suddenly has calf pain. That is why we needs to order further Ix. no smoking. no cough. 16. Cooper 375. Ix: Doppler US: thrombosis at level of left lower leg. At the end of the day if she changes her mind. No night sweat... no pill. disadvantages of each method) Examiner asked what kind of IUD.. Then I advised if the is no complaint with pill she can continue with it or try others: depoprovera. When I ask if she has any concerns.. bumps on the body recently. When INR 2-3 stop Heparin and cont with Warfarin. no lumps. thrombophilia screening test. I finished early. Due to clot in vein. she is healthy. no chest pain. At GP clinic. Thrombophilia screening for Tx: If there is Fa trait.

AMC Clinical Examination 19 March 2011. black stools. She is concerned about this because her 32 years old sister gave birth to a baby with Down syndrome. k.. Apart from knowledge. History taking How are you today? The RP said I am good. cause decreased INR. is that correct? Yes. Aspirin … cause increase INR. Nexium. They looked happy and did not ask me anything. practise repeatedly then everyone can make it. Rulide. manage the case and counsel the patient accordingly. Best wishes to all of IMG candidates who is struggling for AMC exams. And intereaction of medication: pill. Needs to come back immediately. K? She said o. Good luck! At the time I realised that was my last station! AMC feed back: DVT I tried to write in details what happened in the exam so you can roughly know about the real situation. As far as I know. related your pregnancy. She has already decided not to continue this pregnancy if she found that her baby has Down syndrome.Then I mentioned about SE of medication: bleeding gums.. Study hard. and is that O. Passing this exam is just the end of the beginning. Before we get to that point. red urine. Please help each other because we still have many other exams. I was about to run to the next station. you want to get information about risk of Down syndrome. Antacid. I think. I would like to ask you some questions. Task: take focused history. the more appropriate you can manage to response to the examiners' Qs or the role player acts the better outcome you can get. The examiner said you finished your exam. Melbourne O&G (1) 24 years old girl with her first pregnancy at 10 week gestation came to your GP clinic to ask about Down syndrome. . Corticosteroid..

it can be suspected for Down syndrome. However. In general population. a diagnostic test can tell for certain if the foetus has Down syndrome or not. it is less likely to have a Down baby. Is there a genetic problem in your family apart from Down syndrome. Explanation and answer the questions Then I asked her what you know about Down syndrome and explained to her about Down syndrome. I explained that there are 2 sets of tests available: one is screening and the other is diagnostic. PAPP. quadruple test is done during second trimester (4 markers in your blood which are either protein or hormone). Do u have any medical problem that I should aware of? No. the risk of having a Down syndrome baby is 1:600-700 but the risk increase with age and if there is family history of Down syndrome. 5% risk of miscarriage (1:200). If you want I can refer you to obstetrician who can explain to you about the chance of having baby with Down syndrome and about the invasive procedures in detail. Have you already seen the doctor and done all blood test? All results were normal. cleft lips or cleft palate? No.I asked her how your pregnancy is so far. and BHCG) which is done during the first trimester (typically at 11 to 13 weeks of pregnancy) and the second. you can decide what is best for you and your family. There are two tests available which are invasive procedures and require putting a needle into the uterus or placenta and removing some fluid or tissue. Are you taking folic acid? Yes. The advantage of Down syndrome screening tests is that they only require a blood test from the mother and an ultrasound to check the neck thickness of the foetus. so there is no risk to the pregnancy. The first one is triple test (USG. if both tests show abnormal results. It is a genetic disorder that associated with advanced maternal age however it mostly occurs below 35. There is no right or wrong choice. I would like to offer you the definitive tests. Do u smoke or drink alcohol? Are you on any medication? No. you will be then put in a high risk group and need to have another test done. If both tests are negative. Since you have family history of Down syndrome and you do not wish to continue the pregnancy if you found your baby carries this gene. On the other hand. rather. You can discuss with your husband and I can arrange another meeting with both of you. But it carries1% risk of miscarriage . they tell you whether there is a low or high risk that the foetus is affected. screening tests for Down syndrome cannot tell for certain whether your foetus actually has Down syndrome. and Amniocentesis which is done at15-18weeks and need to wait for 2 weeks to get the result and which carries 0. if they are higher or lower than normal. Chorionic Villous Sampling which is done at 11-13 weeks and the results will be back in 48 hours. I asked RP do u understand what I am explaining to u so far or do u have any concern? Then RP asked me "Do you still offer me diagnostic tests if the screening tests are negative?" I said. AMC Feedback: Explanation of foetal abnormality screen (passed) . which is a diagnostic test which is nearly 100% accurate to detect Down’s syndrome. . But the decision to have diagnostic tests depends on your wishes.

asked me again what you want to know. it cannot continue to term. nausea and vomiting. Order necessary investigations and explain your management plan to the patient. As the pregnancy is not in the usual place. I said BP. She is married and not on any contraception because they are trying to conceive. According to the history. PID. Task: Take history. I went for focus examination of the abdomen and pelvic. but on bimanual examination. 6/10. Quantitative BHCG and USG results were not available. No past history of STD/PID also. this can be in the tubes between your womb and ovaries as in most cases or inside the tummy. When I asked about the symptoms of pregnancy. I asked about waterworks and bowel motion. no rebound tenderness. When I asked RP. it was about 3 weeks ago. Explanation and Management Then I explained to the patient. T _all normal. the examination findings and the test result . have u done a pregnancy test. UTI History taking I asked examiner whether my patient is haemodynamically stable or not. Urine dipstick normal. My DDx of pain in RIF: Appendicitis. I understand that it is very disappointing for you. ask examination finding from the examiner. Then I asked all pain questions: pain started suddenly last night. Threaten abortion. Pelvic examination: no discharge on inspection and os is closed on speculum examination. She mentioned as normal. No renal angle tenderness. When asked about the LMP. she denied. moderate amount. there was tenderness in the right culs. no discharge or blood from the vagina. Ectopic pregnancy. there is a high possibility that you have what we call “Ectopic pregnancy” that is a pregnancy outside your womb. Twisted ovarian cyst. PE Since I have known the vitals. and no pain. all tests suggestive of appendicitis– negative (no need to ask but want to make sure). which is very rare. Have u ever been pregnant before? She said no. PR. I offered the RP painkiller but she said it’s ok.(2) 22-year-old lady came to ED with right sided abdominal pain since last night. not relieved with anything. Ut size is normal. the examiner said it was positive. around right lower part of the abdomen and radiate to the back. He . regular. not associated with fever. Pain in RIF.

and have a look at your womb and tubes. Depending on this. level of BHCG. Have you ever been diagnosed with STD/PID? She said NO. . there is a chance of having pregnancy every alternate month. ask physical examination findings from examiner and counsel the patient sterilization and other contraceptive methods suitable for her. may I ask you a few questions? RP said it’s ok. Can you tell me about your period? It was regular and heavy before taking pills. AMC Feedback: Probable ectopic pregnancy (passed) (3) 35. So I do not want to use any hormones for more than 20 years.year. She said “I do not want to introduce all these hormones into my body and I will continue to be sexually active for another 20 years. the obstetrician will decide either to inject medication or remove the foetus by operation. she or he will make a definite diagnosis by laparoscopy or key hole surgery. First you will be put to sleep. and then they will insert a tube with lens through a small incision in your tummy. Do you have any questions that you want to make clear? Can I become pregnant again? Yes. there is still chance that they need to remove the tube in case it is damaged.old woman came to your GP clinic because she wants to discuss about sterilization. I asked the reason why she doesn’t want to continue to take oc pills anymore. She has 3 children and has been taking oc pills for a long time. But still there is a chance of having ectopic pregnancy in your future pregnancy. (If tube need to be removed. Although the doctor will try to preserve the tube. viability of the foetus. Task: take focused history. History taking I introduced myself and said from your notes I understand that you want to discuss about female steralization. When was your last papsmear? 6months back-normal Do you have any past medical problems? Have you undergone for surgery? Yes. but now regular and normal flow after taking pills. Since I have completed my family. When was your LMP? It was 2 weeks ago. it was a very complicated procedure since appendix was burst. you can as there will be one tube and ovary left even if the affected tube will have to be removed. Before we come to this point. Then she continues to talk about that procedure in detail.Now you need to be admitted to the hospital where you will be seen by obstetrician. I want to do the sterilization. Treatment will depend on the size of the sac.

method. (Mirena)_can last for 5 years suitable for those with heavy period No Male sterilization-Her husband does not want to have this.At that time I did not realise that why she kept saying about appendectomy rather than sterilization. I do not want to go to the clinic every 3 months. Then I offered her different methods of contraception. any relationship problem(no). Reverse process is very difficult and involves complicated surgery (about 50% can be pregnant with high risk of ectopic pregnancy. possibility of Rejoining. besides this is also hormone. RP asked me what about my period after sterilization. the examiner said all normal except there is a paramedian scar on abdomen. so u need to use condom. On physical examination. It will not protect from STD. failure rate. AMC Feedback: Request for sterilization(passed) . Implanon (It is like a small stick which will be put under the skin of the arm) And last for about 3 years. Depo Provera (this is the injection form and need to inject every 3 months). it is usually done with laparoscopy but in your case since you have the scar. Anyway I continue to ask her about her last Pap smear (normal). Regarding the procedures. any medication that she has been taking (nothing except pills). I will refer you to the gynaecologist to discuss further about the procedure. Explain it’s a permanent procedure. It will not change.

Is she feverish? Yes. redness . But most likely your child has a condition called septic arthritis that is inflammation of the joint due to infection through the blood. Yes when I was changing her clothes and holding her limbs. presented to ED with her father. investigation and management. I asked can she walk properly before. Yes. Physical Examination General appearance (drowsy/alert) _child looks ill.Paediatric (1) 12 month old child. refuse to stand for 24 hours. osteomyelitis and transient tenosinovitis. deformity. Respiratory /CVS/Abdominal examination _normal. I forgot to ask whether there are any swellings in either of the limbs. bruise. temperature . she cried a lot. Vitals (39C) ENT examination_ normal. ask examination findings from the examiner. Your child need to be admitted to the hospital where she will be seen by ortho registrar. Any viral I illness before? Any fits. chest x-ray. How is her general health so far?(healthy child)BIND Normal. discharge from ear & nose (No). Lower limb examination what do u wants to know? I asked can the child stand(NO). Explanation and Management I explained to the RP: From history and examination. high fever for 48 hours. noisy breathing. What about water works (does the child cry when passing wee) and bowel motion? Normal. Any trauma to the limbs. other necessary investigations depending on the initial results RP asked: Is my daughter condition serious? . swelling. tenderness (Examine joint above and below) there is a swelling . Has she been crying all the time or at particular time (like when u touched her limb). She will be put on antibiotics after taking blood sample to find out the causal organism. tenderness in left knee joint and other finding are normal. No. Septic arthritis . History taking I asked the RP. I am thinking a couple of possibilities. from your notes I understand that your daughter refused to stand for 24 hours. Can you tell me more about it? RP said it happened all of a sudden and the child was crying excessively that’s why he brought her to ED. then joint x-ray. Task: take focused history.

and explain the management plan to the father. pets. Task: take focused history. How many days in the week does he have the symptoms? 3 to 4 days Does he have symptoms in the evening? How many nights does he have the symptom? 4 nights How is his sleep? (Can sleep well)Has he ever been admitted due to severe asthma? No. Doctor will switch to the most appropriate drugs once blood result came back. Is he allergic to anything else? Explanation Then said. Why did it happen to her? Bell rang AMC Feedback: Septic arthritis (passed) (2) 4 year old girl went to ED yesterday due to acute attack of asthma followed by upper respiratory tract infection. smoking. I know how to give the medicine. Today. How long does she need to take antibiotics? IV for 2 weeks followed by oral for 3 to 4 weeks depending on your daughter condition. Flu. but with immediate treatment and proper care. she will be ok. I will give your daughter ventolin only. Just went to ED. ok I will check it later. What treatment is he taking? Ventolin How do you give him ventolin ( 2 puffs with spacer ). What happens in between the attacks? Do you have symptoms between the attacks? Yes. History taking From the notes I noted that the child got the acute attack of asthma yesterday? Can you tell me more about it? What did the doctors gave her? When was she diagnosed with asthma? (3). Ask to avoid triggering factors and wash the spacer as well . How often does he get admitted? What do you think is the reason or what triggers her asthma? Viral infection .Yes. Father came to your GP clinic for follow-up. Do you know how frequent you get the symptoms? 4 attacks within 8 months.

How is her interaction with friends and with you? Fine. comes to your GP clinic as she noticed the rash in the vulva area of her daughter.If the child need ventolin more than 1 day a week Advise about activity and growth of child I gave Asthma action plan – 3 copies Advice to stick the copy at the fridge Explain what to do when the condition become worse. Physical examination: GC –alert and happy. Ok. vesicles. How’s her relationship with your boyfriend? (Good) he is a nice person. ulceration. rash. Although RP gave me hints to add steroid I could not respond. and colour). Yes. and trauma. Why do you think like that? She said her daughter does not want to go back to her father place and she noticed the rash in the vulva area of her daughter. Similar rash in any other part of the body. allergy. itchiness. onset. discharge. (this is my last station). Any bruise. physical examination and manage the case. I could not find any evidence suggestive of sexual abuse. Wherever you go – Bring asthma action plan Always bring reliever. Have you noticed any abnormal behaviour like strange posture? No. She thinks that her ex husband is abusing her daughter. bleeding. Start with the detail history of rash (site. I understand your concern but before we come to this point. spacer I failed this station because I did not add steroid which is very important. and valvovaginitis). But I understand your concern for your daughter so I will refer her . She thinks that her Ex husband is abusing her daughter as the girl who has been visiting her father refuse to go back to her father’s house. no ulcer. can I ask you a few questions. Take relevant history. no discharge) Explanation and Management Based on history and examination. History taking I asked the RP about her concern. What about her water work and bowel motion? Normal. There could be other possibilities like (foreign body. Has she got any allergic history? SAD questions for all. With whom is she living apart from you? (my boyfriend). scar (all over the body) _No. AMC Feedback: Chronic Asthma (failed) (3) Mother of 4-year-old girl. who has separated from her husband. External genitalia_rash (no bleeding.

. Ok. I said since your mother is not responding to medication. with long standing history of depression. police. headache after waking up. I am Dr…. Task: Explain to the daughter about the indication. So the patient needs to fast before doing this procedure. So she can harm herself if we do not control her condition very well. They will also interview you. Psychiatrist has decided to do ECT (electroconvulsive therapy). I understand that you are here to discuss about your mother condition. They will examine your daughter thoroughly and take sample from your daughter private part. They have a team where many people involve – doctors. She seemed to be confused. She might feel confused. and social workers. what was that? ECT is a short wave given with electrodes from which current passes to the brain that induces a seizure. . Have you ever heard about that? No. Since we cannot wait for 4-6 weeks for the antidepressant drugs to kick in. Only in one condition like if there is any mass or recent haemorrhage. The purpose is to change the level of chemical in the brain. the advantages and disavantages of ECT. I will explain about your mother condition and the treatment she will need. So we will do CT of head first to exclude this. . Bell rang AMC Feedback: Sexual Abuse(passed) Psychiatry (1) 50-year-old woman. has been admitted to the hospital for severe depression with psychotic features. RP: What do you mean my mother can have another condition? I said we just want to exclude whether is there anything in her brain that can increase the pressure in her brain. your ex-husband and boyfriend. where we can’t do this procedure. psychiatrist has decided to do ECT. RP: Then she asked why they decided to give ECT to her mother. Yes. RP asked me it sounds dangerous? I said it is safe and effective. Then I said this is part of the procedure. We will try our best to give you the best possible help to solve your problem.to child protective service. she has psychotic features as well. If you want I can offer you the support group. this is the most effective way of treating her depression. I will follow you up. So. not eating nor drinking or not caring herself. It is given with general anaesthesia along with muscle relaxant. She has been on antidepressant but not responding well to this medication. History taking Hi Ms ….

RP: What do you mean by respond? I mean if her condition improved after giving ECT. Now she is ready to be discharged. RP: Are you sure that my mother condition will be completely cured after receiving ECT? I said the condition will be improved but not cured so she will need to take antidepressant. if u have concerned I can arrange meeting with psychiatric to clear any doubt. Number of treatment given will be decided by psychiatrist. AMC Feedback: ECT (failed) (2) 18-year-old with DM type1 has been in hospital because of DKA. You are a HMO of that hospital. RP : Will my mother condition be cured after giving ECT? We uusually give 6-9 sessions of treatment to patient. Normal weight. Explained her everything. But when I came out of the room I realised that I forgot to mention the name of this condition (bulimia nervosa) which is one of the task. we only use antidepressant to control mild to moderate depression.RP: Why did not they give ECT if the response is good? Why did doctors treat her with antidepressant without doing ECT previously? We decide to give only to those who have indication like severe depression and suicidal ideation(like in your mother case). This is exactly same recall with opening statement “Are u going to tell my GP about this’’ I ensure her about the confidentiality. Task: Explain her about the eating disorder she has and counsel her about the management. I could not convince to RP and the bell rang. use laxative and history of self induced vomiting after binge Eating. Otherwise. The patient records were given. It depends on individual patient. AMC Feedback: Bulimia nervosa (failed) Medicine & Surgery (1) 60-year -old man went to the hospital where stressed ECG test was done and it was found to be positive for ischemia showing ST segment changes (probably anterolateral segment). we will consider continuing or not. sometimes people respond after 3-4 sessions. He has . She has a history of binge eating. But.

Blood pressure is 130/80 mmHg. cigarettes/day for over 20 years. yes but once your condition has stabilized. Feedback: Angina Pectoris(passed) . It occurs due to deposition of fat like substance in the coronary vessels resulting in narrowing of blood vessels that supply to the heart. he will do necessary investigation and depending on the result – the cardiologist may decide next step. Hopefully we will try to achieve that level gradually with diet and exercise. blood pressure is also within normal limit which is again very good. If not. For that I would give you the contact of the trainer. cholesterol is 6 mole/l. But your BMI is about 35 which fall into the category of obesity. Lifestyle modification: The first one is alcohol since you do not drink alcohol which is good. It is a condition where people present with chest pain due to shortage of oxygen to heart muscle. . Your stress ECG result shows that you have a condition called angina pectoris.history of smoking for 20 years. Cholesterol level is 6mmol/l (slightly high). we can prevent serious outcome. Now he is on anginine. Task: Explain to the patient. Bell rang. His BMI >35. they will assess you and give you the exercise program within your limit. Then RP asked me can I have sex. Would you like to consider stopping smoking? Ok. But I would like to advice not to use drug like Viagra. I will refer you to the cardiologist. I will arrange consultation to quit smoking. So I will refer you to the dietician first to work out on a diet plan and I would like to suggest you to do exercise like brisk walking but not at the moment. Aim for body weight is between BMI 20-25. if failed. we may start you on certain medication which lower cholesterol called statins. so we need to control risk factors first. Could not say anything more. I understand that you are here to discuss about the test results. Am I correct? Yes. It can be due to several factors. I also found that you have been smoking . Then. but I need to order lipid profile to check other lipid and will control the level with diet. . Second. Since cigarette smoking is one of the risk factor for your condition. Do you have any concern? Is my condition serious? Not at this moment if we control all these risk factors aggressively. the results. I started this station with explanation of the result… Mr … from your notes. So. then we will consider using medication.

lack of energy. The Rp said NO. yes it showed serum ferritin and transferring saturation is increased. Viral serology-Negative. Since you have raised liver enzymes without drinking alcohol and not having viruses in the body. and heart problems. but the viruses that can attack the liver and causing raised liver enzymes are not found. has developed. The USG showed small gall stones and slightly enlarged liver. abnormal LFTs (ALT -raised. You have inserted pacemaker for heart problem. small gall stones. loss of sexual drive). testis (atrophy. heart (rhythm problem). abdominal pain. Alkaline Phosphate-slightly increase). And the results showed that your liver enzymes are increased. loss of sex drive. But I still need to confirmed this by ordering iron study (at that time examiner gave me the result). if cirrhosis (scarring of the liver). the future outcome might not be good. just to remove 500ml of blood every week until iron level goes back to normal Treatment cannot cure the conditions associated with hemochromatosis. He has inserted pacemaker for bradycardia. USG showed slightly enlarged liver. It is a genetic condition where there is a defect in the gene which helps to regulate the amount of iron absorbed from food. pancreas (diabetes_DM). That's why people of this condition usually complain of fatigue. I asked RP do you have any idea about this condition (haemochromatosis). first examiner said not available then said 8mmol/l (I guess no other tests are available). skin (pigmentation). Task: Ask further investigation. But I need to order HFE gene study (examiner gave me another card) which showed C282Y is positive. which means storage of iron in the body is high. which leads to a normal life expectancy. Treatment is simple. hepatologist. he/she will do biopsy (taking the tissue sample from the liver). but it will help most of them improve. Do u have children? He said no. . However. From this referral notes. liver (cirrhosis). I asked for blood sugar level.(2) 50-year-old man comes to your GP clinic that has been referred to you by another doctor with the complaint of tiredness. I will refer you to the specialists. I am thinking about the condition called haemochromatosis. I understand that your previous GP ordered some blood tests because you complained of tiredness. Because of this defect the body absorbs too much iron which deposits in different organs if not detected and treated early. He is non alcoholic. counsel the patient depending on the results. Bilirubin-normal. So I explained to the patient that my suspicion of haemochromatosis is confirmed by this test.

Examiner asked do u think the raised liver enzyme could be due to gall stone.Do u have siblings? Yes I said all siblings (first degree relative) should do blood tests to see if they have the disease or are carriers. AMC Feedback: Abnormal Liver function Test(passed) . I said no. For this I will refer you to the surgeon with whom u can discuss about the treatment option. Gall stones are just incidentally found.

old young man came with severe headache. FBC. Explanation From history and examination results. No rashes. Kernig sign (Negative). ask physical examination from the examiner and explain diagnosis to the patient. you will be seen by neurologist and will order CT scan. Task: Take history. Any trauma recently (No). blood culture. Any problems with the sinuses. ESR. DDx of headache: migraine. tumor.year. You need to be admitted to the hospital.(3) 22. I thought that it is just normal headache. You are HMO at the ED of the hospital. . but I still need to rule out some lesion in the brain (tumor). I forgot to mention (haemorrhage). He asked me what else. cervical spondylosis. haemorrhage (trauma). NO Physical Examination GC: conscious & ill. onset. reflexes) . they will consider to do LP if CT normal. severity. the most likely condition you have is what we called meningitis (inflammation of the covering of the brain). tension headache. no fits but sensitive to light]. power. severe. Then I started with pain questions where. Neck stiffness (positive). Fundoscopy (can’t see properly due to flashing light. You will be treated according to the results. need to dim the light?). s o I was staying at home. Any pain in neck? (NO). At the hospital. Is my condition serious? Yes. Any similar attack before? All No. Any contact with sick patient recently. Blood glucose. Then. no nausea &vomiting. sinusitis. ”RP said its ok. radiation aggravating or relieving factors. Neurological examination (Tone.All normal Urine dipstick (normal) Examiner asked me to talk to the patient about the diagnosis. not relieved with pain killer. CRP. Any weakness in any part of the body. (to rule out the condition that can increase intracranial pressure). [Pain around the head for 2 days. History taking I asked the patient “Are u comfortable to answer my question or do u want me to relieve your pain first.

I asked BMI (as u see). Groin pain which occurred after lifting something. ER. Pain aggravated by climbing stairs. gardener. but Extension-normal. gait. Few days back. Back pain. movement. Tenderness at the vertebral column (not specific) No fix flexion deformity. Task: Counsel the patient. I think you have a condition called osteoarthritis. power. back pain is not that much giving him trouble.AMC Feedback: Headache (acute) passed (4) 50 years old. Besides No history of trauma. Adduction. AMC Feedback: Hip Pain (Passed) (5) A 50 years old female was diagnosed with ca caecum about a few months back and surgical procedure was done (entero-enterostomy). special tests. complains of long standing back pain and groin pain. for a long time. severity 6/10 . posture. He has no other medical problems. bell rang. sensory. Flexion. deep seated pain. no pins and needles sensation. and sciatica (less likely). Not relieved with pain killer. . I started with pain question: Pain around groin area. diagnosed with lumbar spondylosis. Now she had severe pain in her lower back and lower tummy region which was not relieved by pain killer. Straight leg raising -normal. no radiation. Sensory and reflexes were normal. But there were some cancer cells left in the pelvic. not with walking or sitting. Could not say anymore. I explained to the RP that from history and examination findings. I will order x ray & see is there any arthritis changes or fracture or dislocation) If not could be nerve problem. she presented with intestinal obstruction when she was readmitted to the hospital where operation was done again to relieve obstruction. but at the same time I need to rule out hip dislocation & fracture (which are less likely). Take history. IR. Physical examination showed tumour has spread within the pelvic and is now in incurable stage. Relieved with physiotherapy now. Examination findings will be provided which u asked for. ask for examination findings and discuss your management to your patient. Results were limitation of Abduction. So if necessary I will refer.

She has had menopause for 15 years but not on any hormonal therapy. g. or on any medication such as prednisolone. exercise. Last Pap smear was done _ year’s back which was normal and mammogram done 6 months back that was normal too. The patient doesn't like milk. dairy products and doesn't do any exercises. thyroid and renal disease. RP asked me do I need to do exercise now. I advice her to limit alcohol drinking within safe level. No I will refer you to specialist for fracture. You need to take rest till pain subsides. Then I said yes I will refer you to the specialist to rule out a condition called multiple myeloma. AMC Feedback: Osteoporosis (passed) . family history). advanced) passed (6) 70 year-old lady with L4 compression fracture and back pain with t score -3 (DEXA scan). Take history. alcohol drinking. I asked the RP about the risk factors (body weight. She has no history of hypertension and diabetes mellitus. Encourage her to take dairy products and provide her pamphlet containing the lists of products and the amount she need to take. She does not smoke but consumes 2-3 drinks of alcohol a day. explain the nature of the result and counsel her regarding management. calcium in her diet. Then you will be put on bisphosphonates and calcium supplements. DXA scan which can predict an increased risk of osteoporosis and fracture showed t score -3 which means you have a condition called osteoporosis. Family history I explained to her about the results. Do you have any idea about this? It is a condition leading to thinning of bones with reduction in bone mass due to depletion of calcium and bone protein so that they become weak and brittle and prone to fractures. Her body weight is normal. after the menopause where the body (ovaries) stop producing female hormone called oestrogen which is important for forming bone mass. come to your GP clinic for result.Breaking bad news: As usual AMC Feedback: Carcinoma of colon (recurrent . Another reason is lack of Ca in the diet and lack of activity. It is found mainly in middle-aged and elderly women. Any concern? RP asked me can there be other cause for this fracture. Brisk walking for 30 minutes 4 times a week). What I would like to do now is I will give you the pain killer to relieve the pain first. Take regular weight-bearing exercise such as walking (e. taking cortisone and HRT. cigarettes smoking.

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ask for investigations and explain immediate and future management. acute psychosis and is at risk of harming themselves or other people. It is indicated when the patient has severe mental illness not responding to medication such as major depression. Task: Take further history. Also indicated when patients cannot take medications because of other medical problems. Task: Do complete respiratory examination within 6 minutes and present your findings to the examiner. AMC Feedback: DVT (passed) (8) 60-year-old man. 1. I explained ECT-the use of electricity to correct the chemical imbalances that cause your mother’s symptoms. its indications. She is taking HRT. . recently becoming more and more SOB on walking up hills. A middle age woman has major depression with psychosis and suicidal idea not responding to antipsychotics and antidepressants. address the concerns of the daughter. AMC Feedback: Respiratory Examination (passed) Sydney 9th March 2011. Mother and sister have DVT. We apply the electrodes on the head. It is performed under general anaesthetics. Advantage: quick method to help the patient.(7) 55 year old lady presented to GP with the complaint of swelling and pain around lower part of right leg. morning session. Her daughter is concerned about procedure and sees you in GP office. Tasks: explain the procedure. and it is the case of your mother. advantages and disadvantages. She is in hospital now and the psychiatric team decided to give her ECT. chronic smoker. then deliver electrical activity that cause convulsion and correct the problem.

I asked the role player several times – whether she has any other concerns. Feedback: ECT. Questions from the role player: It looks terrible on movies. Only a small chance that memory loss may be persistent. Her weight is normal. A young lady with type 1 diabetes admitted to hospital because of DKA. no financial problems. indications and effects 2. She would not feel sore when she has the procedure. is it sore? – Yes. Since then. She has had a good relationship with her partner but was upset when he gave nice compliments to the dress of another girl who looked much skinnier than her. I failed this station and did not know why. Task: take relevant history. it looks more terrible than it is. I addressed confidential issue before taking history. She has supported family. sleeping normal. - I did not know what else to discuss as I covered these points within 3-4 minutes. no depressed mood. We need to consider the benefit of treatment and its side effects. Psychiatric review confirmed that she has bulimia nervosa. Sometimes skipped insulin and thinks it works. A ward nurse said she has confessed to skipping insulin and inducing vomiting after having heavy meal. she is working. No excessive exercise. explain the diagnosis and management. everything is done. She is now stable and about to be discharge. We work together with psychiatric team and anaesthetic team. no suicidal idea. which may be persistent. she has tried to lose more weight by diet because she thinks that she is too fat. no delusion or hallucination. Periods have been regular. Sometimes she eats excessively and induces vomiting because of feeling guilty.procedure. . Will my mother loose her memory and cannot recognise her children? – She may have temporary loss of memory but will recover with time. make sure that your mother is not suffering.Disadvantages: temporary memory loss. She will be put to sleep and when she wakes up. She said no. appetite normal. risks of anaesthetic drug reaction.

including cough. A 3 year old girl was discharged from hospital 2 days ago because of asthma attack. the psychiatrist can give you medications to reduce the anxiety about your weight. no carpets. that’s OK but at the stage that you cannot cope with the anxiety about your weight. get worse. unstable blood sugar levels. I added daily corticosteroid inhaler apart from ventolin and explained what to do when well. I understand you are very concerned about your weight and that concern affects your health. the patient has had asthma since she was 1. Skipping insulin can also worsen diabetes control. Task: Take relevant history. At the moment. She was happy with my advice but at this stage she said I don’t like to see psychiatrist. Feedback: Asthma (paed) 4. I took one after asking the examiner and filled it up. your diabetes can not be controlled well. I’d like to refer you to a counsellor who can help you to cope with your concern. also refer you to a dietician who can give advice on good diet. complaining that her daughter does not want to go to her ex-husband. On history. unwell. A mother of a 4 year old girl came to see you in GP practice. write asthma action plan and explain to the patient. eczema. Feedback: Bulimia Nervosa 3. no smoker at home. Her father comes to see you today in GP practice for following up. She noticed some redness in the vulva and suspected sexual abuse. ask physical examination and manage the case . There were no known allergies. She asked why? – Because if you try to induce vomiting there is an increased risk of tooth decay. wheezing.I said your weight now is normal and you do not need to lose more weight. Tasks: take relevant history. she has had regular day and night symptoms. SOB.5 years and has been treated with ventolin puffer when she has symptoms. She looked happy but… I failed this station unexpectedly. The examiner was very nice. I said – if you don’t want to see a psychiatrist. On discharge from hospital. and electrolyte imbalance that can lead to death. gave me her empathic smile when I had difficulty explaining 4×4×4 strategy in the last seconds. There was a stack of asthma action plan forms on the table. no pets. Time ran out when I was explaining 4×4×4. she still has 3 days of prednisolone tablets to go. She also has symptoms when playing. asthma attack.

No other symptoms.nothing else to say… Feedback: Sexual abuse (paed). no blotchy cyanosis. take swab from the vulva to confirm the diagnosis. with osteomyelitis as the differential diagnosis. I expressed empathy to her concern with reassurance of being supportive to her. Today she refused to walk. she is 39oC. limited range of movements. Tasks: take relevant history. knee examination: red and swollen left knee. baby needs hospital admission. She is feverish. I will refer your baby to child protection unit. However. the baby was playful. On history. Hip examination normal. On examination. ask physical examination findings from examiner and explain differential diagnosis and management to the patient’s father. The baby’s mother asked: do you think that her father abused her? I said that could be one of the possible causes. a common condition at this age. arrange X-ray of the knee. your partner. On examination. no positive findings apart from mild redness and swelling in the vulva area. Her father at the moment also lives with his new partner. no dehydration.The mother was very angry. and me as well. For management: this is an emergency condition. Other possibility is inflammation of the skin. there are people that can examine your baby. The baby refused to go to her father’s house for couples of weeks after coming back from her father’s house. we will put a canula for her. They will also come to interview those related to caring for your baby such as you. normal development. A father of 2 year old girl came to ED because his daughter cries when he tries to pick her up. She did not tell what has happened. I explained the diagnosis of septic arthritis. the baby has been well until now. I finished this station early after 3-4 minutes. call orthopaedic registrar. your ex-husband and his partner. The baby’s parent separated one year ago and she live with her mom the new partner. 5. Treatments involve . Her development has been normal. take blood for investigations.

She asked about the failure rate. nothing could help to relieve the pain. other examinations was normal. no problems with bowel motions or water work. recent PAP smear . no contraceptive methods. Refer her to gynaecologist to consider whether keyhole surgery is suitable because she has the risk of adhesion due to previous operation. the risks of anaesthetics. no significant obstetrics and gynaecology history. Tasks: take relevant history. severity 8/10. I finished early. gave history of pain with sudden onset. A 35 year old woman comes to see you to ask about sterilization. ask for physical examination. I explained about tubal ligation procedure. She has had laparotomy for appendix abscess long time ago. She had stable partner. Feedback: Septic arthritis (Paed) 6.antibiotics for at least 3 weeks after taking joint fluid for investigations. ask for physical examination. When I entered the room. she may need operation to drain the knee joint. the patient looked in agony because of pain. Tasks: take relevant history. felt a little bit faint. Physical examination revealed a scar on the abdomen due to previous operation.I said 1 in 200. no nausea/vomiting. She held her hands on the right iliac fossa. Feedback: Request for sterilisation (O&G) 7. no previous pregnancy or STD. give diagnosis. pain was constant. Both examiner and role player were happy. differential diagnosis and management. give diagnosis (?). very keen on sterilisation and does not want to discuss other options. The patient has had 3 children. A young woman comes to ED because of severe abdominal pain. no radiation. explain the procedure and other methods for contraception. LMP 7 weeks ago.

is there any way to detect it early so that I will not continue the pregnancy. I said yes. She said. Bimanual examination: uterus size normal. no adnexal mass or tenderness. She was otherwise healthy. pregnancy associated protein A taken at the same time can detect 90% Down syndrome. alpha fetal protein. vital signs normal. A young woman at 10 week gestational age comes to see you in GP setting. On examination. transvaginal US. This combines with some other blood tests such as B-Hcg. there are some options for you to detect Down syndrome during pregnancy.I don’t want to have a Down baby. If the tests suggest that you may have Down baby. no pain/bleeding on intercourse. prepare operating theatre. blood group and cross match. You needs hospital admission. cannot rule out appendicitis. These tests are used to screen for Down syndrome. I said most likely you have ectopic pregnancy. She asked: Is there any risk for those procedures? – The risk of abortion is less than 0. take blood for serum B-hcg . no loin tenderness. The other option is doing blood tests at 16th week including B HCG. no discharge. preoperative assessments. threatened abortion. Because you are under 11 weeks of pregnancy we can arrange Ultrasound at 11th week to see the presence of increased thickness of the space behind the baby’s neck. call gynaecology registrar. psoas signs. Feedback:Possible ectopic pregnancy (O&G) 8. There were no questions from the role player and examiner. cervical excitation negative. no vaginal discharge or bleeding. Task : counselling the patient The woman was very anxious about her pregnancy.5% for amniocentesis and less than 1% for CVS. . McBurney. Rovsing sign negative. Estradiol. Urinary pregnancy test positive. She is concerned about having a baby with Down syndrome as recently her sister just had a newborn baby diagnosed with Down syndrome. suprapubic tenderness. Speculum examination: cervix close. We’ll put canula.normal. may need operation. we need to confirm diagnosis by either taking a sample from placenta at 11th week or taking fluid surrounding baby……..

GP setting. no previous injury to the hip.If it is the case. I failed this station. If the tests confirmed that I have Down baby and I don’t want to continue pregnancy.can I terminate it? By which way?. above 16 week. numbness. give provisional diagnosis and further investigations. weakness of the leg. Stress test showed ST depression Task. develops gradually. no radiation. we can do suction. reduces with rest. overweight.explain about investigations. most likely but there are no test can give 100% accuracy to diagnose Down syndrome. Cholesterol 6. I will refer you to the gynaecologist to discuss more about termination.(O&G) 9. I spent a lot of time to explain about cardiovascular risk factors (smoking. worsens when walking. No significant illness in the past except “arthritis” on fingers (PIP and DIP joints). bypass surgery. he has BMI 35. while waiting for the specialist consultation. we induce labor. On examination. referred him to a cardiologist to consider angiography and other procedures such as stenting. The patient has had hip pain recently (I cannot remember for how long). Tasks: take relevant history. In this station. non smoker. - Feedback: Explantion of fetal abnormality screen. Not on any medication. hyperlipidemia…) and did not have time to start him on statin. Feedback: Angina pectoris. GTN…. Pain felt in the lateral part of the groin. SOB on exertion. aspirin. ask physical examination from examiner. and no weight loss. no hyperglycaemia. Generally under 16 weeks.0.- Are the tests accurate to detect Down syndrome? _yes. no tingling. 10. I explained about the investigations. Dr Wenzel was the examiner. no fever. A middle age female patient came to see you in GP Office complaining of left hip pain. a middle man has had chest pain. no morning stiffness. . (I knew my answer was risky but anyway I passed this station). diagnosis and management to patient. No other joint pain.

no tiredness recently. There were no questions from the role player and examiner. referral to dietician for advice on good sources of Calcium rich foods. last Pap’s smear 2 years ago normal. urine tests to rule out multiple myeloma and other malignancies. Mother had osteoporosis at the age of 80s. I explained about the diagnosis. DEXA bone scan -3SD. biphosphonate and mentioned its side effects. the patient still has pain. no fever. no exercise. Feedback:Osteoporosis. no weight loss. no previous illnesses. Feedback: Hip pain. how to use. Menopause more than 10 years. advice on dietary. The role player nodded her head but said nothing. On history. 11. Tasks: take relevant history. The patient does not take any dairy products. non smoker. . not much outdoor activities. A 70 year old woman who has developed severe lower back pain and XRay shows compression of lumbar spine (L4L5). For management. I gave her pain killers. Systemic reviews of symptoms were all normal. provide management. limited range of internal rotation and abduction. who gave me a big smile when I finished.On examination: left hip joint has pain on movement. My provisional diagnosis was osteoarthritis. explained to patient about the diagnosis. offered further investigations including bone scan. I explained it to the patient and arranged X-ray of the hips. No abnormality on neurological examination. not on any medication. exercise to strengthen the muscles. referral to occupational therapist to make sure safe home environment to prevent falls. blood tests.

Therapeutic range of warfarin – [2-3] Feedback: DVT. no cervical lymphadenopathy. thrombophillia screening. He had no Horner’s syndrome. ABI normal range. recommended hospitalisation in which she will have bed rest. please check other recalls). the examiner nodded his head and said “positive”. she had been fit and healthy. He has been a heavy smoker. 13. stop heparin when INR reaches therapeutic range. On examination her leg is swollen and red with pitting oedema. introduction of Heparin and Warfarin at the same time and relevant daily blood tests. hypertension. ask examiner for investigations. I explained the diagnosis of DVT and the associated risks. Tasks: take relevant history. Questions from the role player: Duration of using warfarin. no smoking. This was a real patient. I asked for Doppler US. about 2 packs a day. A middle age woman developed lower leg pain and swelling after a long trip comes to see you in GP office. A middle age man comes because of SOB developed gradually. She has been on HRT. stop HRT or use the other form because of high risk. (I cannot remember now. no diabetes. no previous leg injury. explain diagnosis and management. I performed respiratory examination according to Talley and O’Connor. Her mother and sister has had DVT. 36 months or lifelong. positive finding included expiratory wheezing on over the . not on other medication apart from HRT. On history. blood tests for coagulation profile.Depends on the thrombophillia test results .12. Task: perform comprehensive respiratory examination and give diagnosis. Her sister had DVT after having delivered her baby. For investigations. pain developed suddenly. her mother had DVT because of ….

Feedback:Respiratory examination. pain management specialist. no liver metastasis. Treatments mainly to reduce symptoms that she may have such as bowel obstruction with colostomy. and then he told me to interpret the result which indicated 120 ml. A young patient with headache developed 24 hrs ago. ask for physical examination. I said-there is evidence of airway obstruction and I’d like to perform the PEFR test after bronchodilator to confirm COPD. The patient performed it correctly at the second go. advanced) 15. A long stem with complicated details which indicated colon cancer previously operated but now having peritoneal cavity spread. He nodded his head with satisfaction.. Tasks: explain the diagnosis and management. The patient was a woman on middle age. I gave breaking bad news steps by steps. social worker… to help you. He asked me what is the other bedside test? – I said spirometry. Tasks: take relevant history. free fluid inside the abdomen. pain with pain management… we work together in team including oncologist. surgeon. the examiner said you have 30 seconds for examination.I’d like to do PEFR test. community nurse. The examiner then stopped me and said other repeating gave consistent results. . Feedback: Carcinoma of colon (recurrent. We will help you to enjoy activities as much as you can. The examiner said – do it! The instrument was provided on the table with disposable mouthpiece. She took it quietly and asked what the available treatments for me were. 14. I quickly said. You do not need to stay in hospital all the time.lung fields.? It is different among individuals. I said most likely chemotherapy and/or radiotherapy. just 1-2 days if you have chemotherapy/radiotherapy to follow up the side effects. and explain possible diagnosis and management. When I was listening to the chest. I also suggested cancer screening for her children. The bell rang. many people with this condition live longer than they have expected. She is now in ED. She asked: How long will I live.

CT scan first to exclude increased intracranial pressure. Other examinations were normal. Feedback:Headache (acute). ALT. neck stiffness positive. GGT). because of the associated risk of coning of the brain.Which one you give first? Why?.On history. You are in GP practice. on over the head with soreness in the neck. lumbar puncture. Physical examination: Temp 39oC. She needs hospital admission for having CT scan of the brain to exclude increased intracranial pressure. no visual disturbances.B. lumbar puncture? Questions from examiner: What are you looking for in CT scan?. numbers of white blood cells. I explained to the patient the possible diagnosis of meningitis. no nausea or vomiting. 16. could be also subarachnoid haemorrhage. brain tumor. The patient asked. blood tests to confirm diagnosis. protein. the patient developed headache for one day. Treatments include antibiotics and symptoms management. . CT scan and lumbar puncture .what is CT scan. you can see he has had pace maker. culture for the responsible bacteria. What would you expect from lumbar puncture?. fundoscopy not available. no radiation. abdominal US shows abnormal liver consistent with cirrhotic change. hepatitis A.Brain tumor or evidence of increased intracranial pressure. persistent abnormal liver function tests (increased AST. From the stem and the letter. feeling hot. BP normal. A patient just comes to your area with referral letter from his previous GP.Biochemistry change including level of glucose. - The examiner was happy with my answers. Systemic reviews were all negative. Pain was constant with 8/10 severity. What is the other test apart from CT scan to check ICP? – Fundoscopy.C serology were all negative.

your first relatives will need screening tests.The patient has had healthy lifestyle. mother DM. Father CABG. unhealthy diet. and the gastroenterologist will consider liver transplantation when your liver is not working properly. liver biopsy. C63D negative Liver biopsy shows fibrotic change grade 2. HDL. Iron studies show transferrin saturation 85%. LDL and TG high BP: 140/85. but lowish. social drinker. Because this is a genetic condition. explained the provisional diagnosis as haemochromatosis and order Iron studies. The examiner looked happy. AMC Clinical Exam Recall 2nd April 2011 Station 1 Total cholesterol 7. non-smoker. non-smoker. increased ferritin. Feedback: Abnormal liver function tests. just the RP wants to know more about healthy diet and reassurance + referral to medics and start on lipid lowering agent Candidate 2 (Brisbane) Status: Passed Same as above! . All positive risks were given as in the stem. counsel regarding hyperlipidaemia Candidate 1 (Adelaide) Status: Passed Just CVS risk assessment (modifiable and non-modifiable) station and counselling. Tasks: explain the tests to the patient. no alcohol consumption.normal. I said – you have some level of liver scarring as the result of haemochromatosis. social drinker Task: History.3. We will need to take blood every week to reduce iron load. The examiner gave me result cards only for the tests that I have requested. possible diagnosis. Genetic tests reveal C282Y positive. genetic test. no exercise. order other tests to confirm diagnosis and management I explained about the test.

BSL 23. not much walking post-op bcoz of pain Sudden SOB. Task: Explain about the result and management. need to refer to hospital. . sweaty. insulin injection for life long (mum and dad are primary carers of the boy). no N+V. no radiation. no significant FHx. Day 5 post-op. he can lead normal life. no meds apart from aspirin. blah. no cough. don’t know why Modified book case Newly diagnosed T1DM. not definitely necessitate admission since he’s physically well at this stage. (no more history or PE) Candidate 1 (Adelaide) Status: Failed. he needs to be closely monitored. urine sugar +. 1 wk h/o lathergic. the examiner greeted me and I started to ask whether my patient is vitally stable or not and he said she’s stable. Invs and Dx (not management) Candidate 1 (Adelaide) Status: Passed When I went into the room there’s a lady lying on the bed in hospital gown. asked PE findings from examiner (only give what you asked for). but. blah. Now complain of SOB. ppl live with this condition and with proper monitoring and control. don’t worry too much. day 5 post-op for total knee joint replacement surgery. PE 50+ lady. 1st time having this kind of problem PMHx: otherwise well apart from knee arthritis.) If confirmed. Insulin Assay. Explain about DM. had 2 days of heparin subcut 5000 BD and prophylactic ABx post op. asso: chest pain-> central. do some fasting blood: fasting BSL. also warn about hyper and hypo-glycemia and glucagon. NKDA. AMC Feedback: Newly diagnosed child DM Station 3 . PE completely normal and the child is well at this stage. The patient’s questions are quite similar to the book case. he’s got increased frequency and amt of urine and also there might be some electrolyte imbalance causing him weak and lathergic and that’s why he needs to go to the hospital and assessed by paeds. the RP wants to know all the Q in book case and show interest in Ketone and hypoglycaemia and glucagon injection. Task: History for 3 mins. no recent H&M. noturia.AMC Feedback: Hyperlipidemia Station 2 T1DM. ketone+. anxious. Lipid. GP. and he can also play sports and no specifically restriction of activities. 7 yo male. RP asked me what dose ketone stand for and the significane (ketone means dehydration in your son. but. r/v by paeds. anxious for last 2 hours. Candidate 2 (Brisbane) Status: Passed Quite similar but I explain more about DKA and to exclude that the boy needs to go to hospital and reviewed by specialist. sweaty. but. and bcoz sugar is osmotically active and draws water. no calf pain. blah.Rest Station 4 Day 5 postop DDx. BSL 4 times a day.

Temp. I told him that my first DDx was AMI and then. the observer and also the RP looked strict at first. gradually worsening and concerns bcoz she’s still young. she’s coping well and the baby’s fine. I asked for general appearance which is anxious and sweaty. he asked me my DDx. How long you’ve been having this problem? Since before this baby born. Q. I felt very good after that station bcoz the examiner. to confirm that I need to do CTPA. He smiled and then. HR around 120/min. but. AMI 2.Then. interrupts me that what was your first DDx (stupid me forgetting troponin even until that time :P). I told the patient. PE 3. He smiled and then. Then. sinus rhythm. he asked me what are you going to do next and asked me to tell the patient? So. I told him that now. 4 mo post partum. I asked the patient again that she doesn’t have any heart failure and the patient said no). SaO2 89% on RA (then. Septicemia. not to worry too much and in the meantime. the RP gave me a very big smile afterwards  Candidate 2 (Brisbane) Status: Passed Same as above! AMC Feedback: Chest pain and dyspnoea (acute) Station 5 30 yo. The examiner looked strict at first sight and asked me what I would like to know. the bell rang. baseline renal and liver function test. I asked the examiner whether my patient has the IV cannula insitu since she is not vitally stable and I would like to start her on oxygen 2L via NP and start to give her IV Fluid (then. And so. Then. but. So. She said apart from the wetting problem. So. Vitals. X. PE is my first Differential so. he gave me the ECG and asked me to interpret that. the examiner. So. I explained my patient that your SOB and Chest pain worries me and I would like to take ECG. I answered < 0. tachycardia. came to your GP for wetting problem. I know that I forgot Cardiac enzyme and I wanted to laugh at myself and told him I would also like to run Troponin. the examiner. Then. then. he asked me what else invs? D-dimer which will be raised by thousands. age 50 yr. i’d like to give you some O2 to relieve your SOB and start on fluid. I cannot find any ST or T segment changes. PR. Dx and mgt to the patient. P2.04 and he said the result came back like that and so. I presented the ECG (this is the ECG of Ms.afebrile. no signs of chest infection) Then. no calf tenderness. for about a year now. he asked me what would you like to do to confirm PE and I told him I’d like to do ECG which will show Sinus tachycardia and S1Q3T3. but. So. PE from examiner (will only give what you ask for). and I can appreciated S1Q3T3. actually. the examiner was very helpful and said thank you very much and also. . Task: History for 3 mins. he asked me the normal value for troponin. I asked for PE findings. I told him 1. CXR and I would like to take some blood from you and run the blood for Full blood count to look for trace of infection. and also. Then.110/min. what is your first DDX now. Then. Candidate 1 (Adelaide) Status: Passed I went into the room and congratulated the RP for the baby and asked if everything’s well with her and baby. just gave me the rest of the physical examination findings which are all normal (normal wound site. BP slightly lowish. he asked me what investigation would you like to do to confirm that Dx. coagulation studies including D-Dimer since I’m afraid you might also have the condition where there’s a blood clot formation in your leg veins and dislodged into the blood stream and obstruct the major artery supplying the lungs and the patient looks a little bit worried. Ht and weight was given.

like burning sensation. Do you need to rush to the toilet when you need to go? No Q.Q. Q. not on regular meds PE: Normal general exam and system r/v. How about the bowel? Fine Q. dry cough as usual . lipid problem? No Q. So. Q. The possible treatment option will be starting with general measures (it’s good that you don’t smoke and keep that good habit. No chest pain. exercise. but. I asked her whether she’s okay if she needs surgery and she asked me back what do I think? So. there’ll be option like vaginal pessaries. Mgt plan Candidate 1 (Adelaide) Status: Passed When I entered into the room. and asked me to start with her. She’s feeling breathless for about a month. DDx. I introduced myself and asked history from her. Any past surg or gynae procedures? No Q. I realized that I didn’t specifically told her to reduce weight. Then. Do you have any other problem with the waterworks. the bell rang at that time and then. and also surgical option. is the amount a lot or just a little bit? Just a little bit Q. I told her that I will refer her to the gynaecologist and she will be reassessed again and treat accordingly. Ask about 5P and all normal. any N or V? No Q. she’s SOB. I told her that I suggest we will start with conservation measures and if not we can consider surgery and I try to tell her the 4 surgical procedures for GSI. blood pressure. She seems to have understanding with my explanation and I told her that the most likely cause of her problem will be due to the big babies she had and overweight might also contribute to that. I explained to the role player that she’s having a condition what we called stress incontinence (incontinence mean that you cannot control your waterworks so well and stress mean when there is increase stress or pressure in her tummy like coughing or sneezing). PE from exmr. But. no orthopnoea or PND. slight anterior vaginal wall prolapsed Bed side UA. PV exam -> Demonstrable stress incontinence + and also. but.ly when coughing and sneezing Q. worsen in 2 weeks and said that now even with daily chores and walking. How about your babies and deliveries? All normal vaginal delivery and both of them >=4 kg. the RP said the examiner hasn’t returned yet. esp. SAD? No NKDA. When you wet yourself. Any past illness. BSL normal Then. no prolonged labour or prolonged hospital stay. BMI 30 With the patient consent. no SOB at rest. Can I ask you some sensitive question? Yes Q. including the pelvic floor exercise) and also. sugar. stingy pain or fever? No Q. Is that worsened when you cough or strain? She said yes. Candidate 2 (Brisbane) Status: Passed Same as above! AMC Feedback: Urinary Incontinence (Passed) Station 6 50 year old lady you are seeing in hospital OPD with complain of 2 wk ongoing SOB (the Q is that short) Task: History for 3 mins.

I talk to the patient that there’s also option of kidney transplant and i’ll discuss with the nephrologist about that and let her know. reduced AE. after seen by Nephrologist. Makes me confused again and I asked the examiner whether renal transplant is the available option. etc. Then.. no stress. She said not good and she said she did not want the treatment.. it is one of the possibility and we do need to exclude this by doing the aspiration.. Vocal fremitus and resonance Reduced. CVS: normal. FBE: Hb. but. he pointed me the next task and pointed at the RP. Do you understand that you’ll need the renal dialysis for the rest of your life? Do you want me to explain you more about the treatment? She said she understands well. but > 100 UEC: ESRF picture (urea 35. Q. results given.. Cr >500. the tension will be relived and you’ll feel better. So. I feel a bit frustrated and then.. she doesn’t want the dialysis and she doesn’t want to be machine dependent and don’t want to go to the hospital 3 times/week. after i’ve finished my history taking. he gave me the PE result sheet. which is also kind of therapeutic since the fluid compress your lungs and cause you SOB (by taking the fluid out. the medical specialist will decide how long they’r gonna put the chest tube in) and if confirmed. She was recently diagnosed as having ESRF and neprhologist suggested that she needs to have Renal Dialysis. So.. dullness on percussion on right lower zone. blah blah blah) CMP: ESRF picture Task: History. the medical specialist will proceed to some other investigation like bronchoscopy and biopsy. I told her that it is not yet confirm as the cause. system r/v normal. no phlegm. So. I decided to ask the psych question from that stage .(smoker). Vitals. but the station is 7 I went in and greet the patient ( she’s holding a tissue paper and there’s glass of water in front of her-> making me even confused coz i think about breaking bad news about ESRF) and ask how she’s doing. Lungs. The examiner told me that do your best with the provided information. the RP asked me you mean nasty growth is that cancer? and she looked worried. which might be result of infection. Candidate 1 (Adelaide) Status: Passed I was confused at first since the stem looks so so medical. no recent LOW or LOA.normal. K 5. quietly sitting and then. The examiner came back after about 2 mins. in which fluid is trapped between covering of the lungs.mild anaemia. and the bell rang Candidate 2 (Brisbane) Status: Passed Same as above! AMC Feedback: Shortness of Breath Station 7 40 or 50 year old lady came back to your GP.3. inflammation somewhere or nasty growth itself. COPD. I started to explain the RP that from my Hx and PE. you are having a condition what we called Pleural Effusion. The RP just repeat again that she doesn’t want dialysis. Blood test were done. Do you know your condition well Latifa? Yes Q. So. do the aspiration of the fluid to examine under microscopy to make sure it’s origin. I told him my DDx: Heart Failure. but.. he pointed me the next task and so. I need to refer you to the medical specialist and do CXR first to confirm the Dx and then. And also she said she was explained by the nephrologist about the treatment and again she repeats that she doesn’t want the dialysis.. And then. Tell the patient about Dx and DDx and Management. LRTI and then. Smoker 20/day for about 15 years. but.

Then. can I ask you some questions first and some of these questions are also sensitive and I’d like to assure privacy. Candidate 2 (Brisbane) Status: Passed Same as above! AMC Feedback: Depressed Mood Station 8 . Task: History for 3 mins. sweaty. involvement of regular activity? Not anymore Q. PE. LOW. According to what you’ve told me. Judgement -> intact Q. blah. 55 yo man. I suspect you are having a condition what we called major depression with somatic features.. Well. blah) Q. Latifa. I will arrange the religious and spiritual group to help you and also social worker involvement for your family since you are also worried about being a burden to your family. So. Sex? Not interested in it Q. Are you okay with the management? She said yes. RP said yes. LOA? Yes Q. blah. However. I need to refer you to the psychiatrist to start you on antidepressant medication and also psychologist to help you cope with your stress. No perceptual symptoms Q. Feeling low or depressed? Yes Q. before we discuss further. RP doesn’t want to be a burden Then. Do you have any idea to harm yourself or others or end up your life? No Q. I know that you are facing a very difficult period of time and I understand that you don’t want to be a burden to your family and you don’t want the treatment although dialysis is the best possible option for you at this stage and with dialysis. Present the case to the examiner as if you are presenting the case to your registrar or consultant and most likely Dx and ask only one most important invs and interpret the invs to the examiner. Candidate 1 (Adelaide) Status: Passed . any recent weight loss? Yes about 10 kg in 1 or 2 months Q..since it is the psych station (if it’s not psych station.rest Station 9 Intern in ED. anxious. Also. And. SAD -> no Q. etc. I forgot to mention the possible differentials. I understand that it’s frustrating to face this chronic illness and hear about the invasive treatment (actually. Sleep? Difficult to fall asleep Q. I think your condition is more serious than this. your lifespan can be extended about 5 years and increase the quality of life to at life to your days. How’s your mood? Not good Q. but. I don’t even want to think about this now. Insight. Home and Family -> supportive. but. I explained the RP. at this stage. but. where you have the depressive illness and as the result of that your body is also facing difficulty in falling asleep and LOA. I’m frustrated :P). I’ll also discuss with the nephrologist about the option of kidney transplant.. and she repeated again that she doesn’t want the dialysis. epigastric discomfort. Q. I felt blessed that the bell rang at that time. Latifa. I’m going to tell her that it’s her choice and we’ll respect her choice and refusal of treatment.

AMC Feedback: Acute myocardial infarction Station 10 . HTN and Hyperlipidemia. Then. X. he asked me what will the old infarct show? Q wave and he asked me to find Q wave in the ECG which I’m not so sure. Male gender. sinus rhythm. I just told him that I think there’s 2 small square of Q in lead III and then. He also has co-morbidities of DM. Examination-wise. Then. but. Then. JVP NE. I ask for pain Qs. Previous history of heart attack. anxious and sweaty looking. no crepts or added sound.The RP looks anxious and SOB. Therefore. Bedside UA: normal Then. I asked the general appearance. J or cyanosis. This is the ECG of Mr. no weakness of limbs. squeezy tight radiating to jaws. vital signs (unable to perform postural BP).. Then. can you show me where exactly it is? Then. Why? ST segment elevation and hyperacute T changes. Comorbidities for CVS risk including DM. N+. He’s got the significant background of previous heart attack 2 or 3 years ago. He’s on medication for his diseases and claimed to be compliant... I told my examiner that I would like to present the case. he asked me how old do you think the infarct is? Very recent within 6 hours.. X.X. look. Then. significant BK of heart attack. not the first time having this pain. Hi. However. So. No widening of QRS. who came in with 2 hour history of sudden onset of central chest pain. HTN and Hyperlipidemia (I forgot to ask about SAD and stress.. he did not have any angiogram done at that time. No recent H&M.. Sweating +.. he interrupted me asking what are the risk to this patient. PR.. PMHx: DM. ST segment elevation in II. So.all present and on regular medications including aspirin and compliant No recent surgery or travel. From the notes I understand that you are having pain in your tummy. I present the ECG to him again. apart from SOB. HTN. Therefore. Age. Hx of DM in mother I forgot to ask about SAD bcoz I needed to rush through my hx fearing that I would run out of time. the RP point around the central chest. he’s vitally stable.. Had heart attack 2 or 3 years ago.. but. my provisional diagnosis at this stage is Acute Myocardial Infarction and I’d like to arrange ECG. No fainting or dizzy spell. anterior leads with reciprocal changes in I and aVL. no V. Hyperlipid . III. Central chest pain. then.. So. No calf tenderness or pedal oedema. He is vitally stable at that stage. this is the case of ST elevation Myocardial infarction. the examiner asked me what are my points for diagnosis? Cardiac sounding chest pain. no calf pain No family hx of sudden death. he did not have any history of recent travel or surgery. blah blah blah. he asked me what does the Q wave mean? I’m not so sure at that stage again and told him that previous infarction and he asked me what else and I really don’t know more and lucky that the bell rang that time  Candidate 2 (Brisbane) Status: Passed Same as above! But the examiner didn’t ask detail about ECG finding. 55 yr old gentleman. hx taking was only allowed for 3 mins and I didn’t feel guilty for that). The examiner said OK and showed me the ECG. Abdo: normal. My name is . aVF which are inferior leads and also in chest leads V1 and V2. no mur mur. JVP is not elevated and systemic examination is normal. did not have any invasive treatment or angiogram.regular. Resp: normal. Started about 2 hours ago at rest. I’m the intern working in this ED. SOB+. I started by asking the examiner if my patient is vitally stable and he said yes and told me to start my task. The gentleman I’m seeing now is 55 year old Mr. CVS: normal. No pallor. PR around 90/min. doesn’t know about Echo at that time.

This is the second baby (first one is about 3 years old and well). this is paeds station. there might be tearing at the end of gullet. came to your GP concerning about infertility. but. vomiting all the time since birth. However. but.. She said her husband is supportive but. The history is just wired. felt relieved So So wired  Candidate 2 (Brisbane) Status: Passed I started to explain the Mom that I suspect a condition called reflux but we still need to exclude other important causes. now more often. she asked me why the baby’s vomiting a lot. since the baby’s vomiting some blood.. I’d like to refer the baby to the hospital. Baby’s still responding well. diarrhoea about 2 to 3 times/day. sometimes postfeed. I told her that’s why I’d like to have the second opinion from the paediatrician and the bell rang. irritable baby. So. crying. The baby was vomiting since birth varying 2 to 3 times or more. Bell rang! AMC Feedback: GORD with oesophagitis Station 11 25 or 30 yr old lady. some blood curds/streaks present recently. I congratulated her about the baby and asked whether she’s coping well and has some support from home.. planned pregnancy. first.. not. I’d like to reassure you that the baby might be having problem as simple as irritable baby. At Hospital. uneventful delivery. Candidate 1 (Adelaide) Status: Failed as expected This is the most wired station. I felt so confused and I couldn’t concentrate well at this station so. HOPS or DA. So. Then. Then I reassured her don’t worry too much because the baby is growing well and PE was normal.. the RP asked (looking angry). fine. the RP is middle aged lady who looked so so frustrated and tired (about to cry with red eyes) carrying a baby (doll). Had immunization at the hospital. When I entered into the room. your baby will be reviewed by specialist and they will arrange required investigation like some blood test and USS and treat accordingly. growth chart: normal. Also. Then.. I told the RP that it is reassuring that the baby’s growing well and PE was normal. She had check up with gynae about 3 years ago for her period pain and invs had been done and turned out to be normal. However. Dx and management. no financial problem.. sometimes. Task: History. vomiting sometimes Task: History. I couldn’t give her the answer at that time. did the baby check with clinic which was normal growth. management . But.. However.. Home situation. So. I can tell from the look that this is postpartum depression/psychosis. If this is psych station. She asked me why there is blood streak and so I explained that due to repeated vomiting. not projectile. ?child abuse PE: unremarkable. I thought I should refer to the hospital.. To my knowledge it doesn’t fit into any of the possible Differentials -> infantile colic.. what will they do? The paediatrician will reassess the baby and if necessary some blood test and USS. since the baby’s vomiting some blood. Then. PE.4 wk old BIBM. no bile. she asked me why the baby’s vomiting a lot.. However. GORD.. Vomitus: milk.. bedside UA: normal I don’t know what to say at that stage. I would like to refer your baby to hospital. both of them are so tired because the baby is crying. no prolonged hospital stay.

Candidate 1 (Adelaide) Status: Passed Hx for both patient and partner- all normal (no previous child or STI in both), apart from infrequent sexual activity: only 1-2 times a month (the RP cannot give the reason, why this happen). So, I asked her whether she knows about the ovulation period. She said she only heard about that, but, don’t know exactly what it is and asked me to explain. So, I explain from the importance of timing for fertility and the need for the ovum to form the baby and I told her how to find out about her ovulation period (her period is totally normal and regular, so, day 14..... basal body temp, cervical mucous, blah, blah blah.....) For management, I told her that I will see her husband also and take hx, PE and possibly, semen analysis. However, at this stage, we can see how we go by timing the sexual activity d/r ovulation period. And I’ll regularly follow you guys up and if no satisfactory progress, will refer to Gynae again for further management. Any other concerns? She said she’s fine, but, one Q-> will I need to take some fertility pill? I told her not at this moment and the bell rang. Candidate 2 (Brisbane) Status: Failed Quite the same as above but I failed this station. I don’t know why? AMC Feedback: Primary Infertility: unknown cause Station 12 55 + year old male patient comes to your GP for pain in lower limbs during walking. He has history of chronic smoking. Task: Physical Examination Candidate 1 (Adelaide) Status: Passed Burger’s test is the main point they want Candidate 2 (Brisbane) Status: Passed Peripheral Vascular Disease (real patient) Reduced temperature, loss of dorsalis pedis and posterior tibial artery pulsation Burger’s test (examiner asked me how to do Burger’s test) Ankle brachial index (examiner asked me the normal value) Abdomen examination for any mass or lesion AMC Feedback: Leg cramps on exercise Station 13 - Rest Station 14 Police officer, ~30 yr of age, previously Dx as essential HTN, now came back for removal of suture, BP 165/100, stopped taking medication for 6 months (was on perindopril), recent blood test: UEC, Lipid, Sugar- Normal. Task: Assess patient’s compliance to medication and counsel the patient Candidate 1 (Adelaide) Status: Passed

She was diagnosed as having HTN while she was interstate about 3 or 5 years ago. At that time, she had difficult time period, lots of stress at work and family. She was compliant initially, but, because of the job nature, she started to miss the medication and experienced no difference and so, stop taking it. However, she did not suffer from the side effects of the medication. About 1 month after stopping the medication, she checked the BP at work place which was normal which reassured her and then, decided to stop taking it. She has family h/o of HTN in her mother, dx in later life. She thinks she’s too young to have HTN and too young to be on life-long medication. Apart from stress, no other CVS risk factor, no symptoms of HTN at all. I don’t even know how to manage it since she checked her BP after stopping meds, currently no symptoms, blood tests- normal. However, I started to explain her the risk HTN will impose on her and immediate risk of death or stroke and requirement to be compliant. I also refer her again to the physician for reassessment. Throughout that station, I didn’t blame her or antagonize her wishes, but, also I didn’t recommend her to stop the medication and also, I advise her on life style changes, stress relaxation techniques. Again wired station. Candidate 2 (Brisbane) Status: Passed Same as above! AMC Feedback: Non-compliance with anti-hypertensive Station 15 17 y o boy came to your GP, he is known to you and healthy boy. Now, seeking some advice regarding the following condition. Picture given showing acne. Task: History, Management Candidate 1 (Adelaide) Status: Failed I went in and greeted the patient asked how can I help him. He told me that he just came today because of the acne. He had that for about 2 years now and since he grew older, it’s quite embarrassing and so, wonders whether I could help him or not. I appreciated his concerns and asked him whether he tried some measures or medications regarding this. He said yes, the pharmacy gave him some cream and not working and that’s been about a month now. Then, I asked him about HEADSSS since he’s teenager and all are negative. He’s generally healthy and parents are supportive; however, he feels embarrassed about this and has difficulty in dating girls. NKDA. Then, I told him that I understands his concerns and understands that’s very embarrassing problem for the teenager. But, I told him not to stress too much about it and we can sort this out. Then, I explained him that acne is mainly due to hormonal changes during pubertal life or sometimes unknown reasons. It is not related to hygiene. Please don’t stress yourself since it is not your fault or due to your hygiene. Just relax and staying cool is the first measure and avoid the facial scrubs coz that might erode your skin. And do you know the name of the cream the pharmacy gave you. He said yes, I wrote that down for you, which is Benzoyl peroxide (i’m really not familiar with that). However, I advised him to stop it since it’s been a month and obviously not doing it’s job and it might also cause some erosions (i’m totally not sure with this thing, please check yourself). Then, I told him, sometimes, acne is associated with some infection, so, we can also try antibiotics. He looks interested and asked me what medication. Again, I’m not so sure, so, I told him that I’ll check with my senior, but, I think it’s doxycycline. Are you okay with that? He said totally fine. And I’ll also follow you up in 1

weeks’ time to check the progress. If not improving, I’ll refer you to the dermatologist for some advices and he would start you on steroid cream (again, not sure). But, for the last resorts, we can also give you retinoic acid and you’ll be fine with that because it has some adverse effects on girls, but, you are a boy and should be fine. Then, I asked him any other concerns, and he said will he have scars afterwards. Good question! Totally not. You might have very tiny scars, but, you won’t be disfigured at all. Then, he asked me his mum said the acne is due to chocolate and he wonders about that. So, I told him it’s just depend on personal preference, if you like it, you can eat it and there’s no documented effect of chocolate on acne. Then, the bell rang and again, felt relieved. Candidate 2 (Brisbane) Status: Passed I reassured him that his condition is called acne vulgaris and most acne usually settles by age of 20 years. I advised him to stop Benzoyl peroxide. He asked me the possibility of scars on his face after resolving his problem and I answered highly unlikely. Then, I told him I want to give him some antibiotics. At that time, the examiner asked me what antibiotics will you use and I said Doxycycline (actually I’m not sure ) Then I explain about general measures (Diet – to avoid too much chocolates and spicy foods as there is some casual relationship in some people and how to wash face gently with normal soap). He looks happy. And I’ll also follow you up in one week time and if it is not well improved, I’ll refer you to the dermatologist specialist to get advices. Bell rang! AMC Feedback: Acne Vulgaris Station 16 HMO in rural hosp. 6 wk old BIBD, problem with feeding for 1 week, poor suckling today. Task: History, PE, Mgt Candidate 1 (Adelaide) Status: Passed First born child, delivered at home, no immunization at delivery, previously well since after birth. Poor feeding for a week, now poor suckling today. No fever, snorty nose, not sure about cough, seems to struggle for breath today. Reduced amount of wet nappies (only 1 for today, which is not really wet). Looks uninterested and lathergic. No family problem, No possibility of abuse. T 36.5, RR 70/min, O2 sats: not done, tracheal tug and IC indrawing +, cannot hear the heart sound well bcoz of fast breathing, bilateral basal crackles + Hepatomegaly 5 cm So, I headed towards Respiratory Distress, most probably bronchiolitis, however, there’s also possibility of pneumonia. Put on O2, put a line in, take blood including cultures, talk with paeds specialist in tertiary hospital, arrange CXR and arrange for transfer. In the mean time, O2 and IV Abx if the specialist suggests so. Also, D/W father about importance of immunization. I also told the father that he or his wife or both of them can accompany the baby to the tertiary hospital. The examiner asked me, what if you observe the baby in your department for about 4 hours and no signs of improvement, what would you like to consider on examination? I really didn’t know what she meant at that time. Then, I started to procrastinate around the possible diagnosis. Then, the bell rang. Later on, I realized that she was asking for Heart Failure as DDx. However, I couldn’t really think that much at that time and also, it was my last station (just an excuse :P) ?? Heart Failure ?? Bronchiolitis or LRTI

5. Wenzel  My voice was shaky for first minute. Admission and manage as heart failure. O2 saturation: not done. I am not sure. smoking. Then he asked me what operations they will do? I told him that. Task: Explain the result and management plan to the patient. Your biggest blood vessels which distribute the blood from your heart to all parts of your body now become dilated. hypertension and diabetes. Came to you for check up and you found abdominal mass and arranged USS which confirmed AAA 5. age. We don’t know the exact cause but there are risk factors such as family history. I think it is heart problem (heart failure) and so explaining about this. the chance of successful operation is very low (just 10%). If you go for the trip and rupture. She was seen by your colleague a week ago. I am sorry I don’t know but I can ask the surgeon and can tell you back. your wife call ambulance and even if we do urgent operation. RR 70/min. Both systolic and diastolic murmur +. Then he wants to know whether he will be ready to go for the trip in next 4 week if he did the operation right now. it might be putting a stent from your vessel at your thigh or they might do open operation and put a graft at the site of dilated part…Bell rang! AMC Feedback: Abdominal Aortic Aneurysm Station 18 . bilateral basal crackles + Hepatomegaly 2 cm So. there is 60 year-old gentleman sitting there. It depends on your condition. PE and invs were done and she was diagnosed as having OCD (they give the . I told him that I won’t recommend you to do so because there is the risk of rupture. I managed to control myself  Candidate 2 (Brisbane) Status: Passed When I enter the room. There is the risk of rupture especially if it is more than 5 cm. the chance of success is 95%. The patient came back today for result. I told him that if we operate now. She has repetitive intrusive and irresistible thoughts of washing her hands very frequently because she thinks her hands might be contaminated and transmits infection to patients or family member. I told him that. I failed this station so please check other recall. This is my first station and my examiner is Dr. BK h/o HTN on perindopril.Rest Station 19 30 yo nurse came to you where you work as a GP. But I explained his condition. So I told him that.3 cm. Candidate 1 (Adelaide) Status: Passed This is exactly the same as previous recalls.Candidate 2 (Brisbane) Status: Failed PE: T 36. But he wants yes or no answer. He asked me can he go to trip and do operation after that. I failed as I did not tell differential diagnosis like bronchiolitis! AMC Feedback: Respiratory Distress Station 17 60 yo man planned for caravan trip in 4 weeks’ time. Chest indrawing +. but.

I’d like you to relax and reduce the stress. colleagues and also the patients coz if she’s so stressful and anxious at work and home. I told her that it’s a good idea to have a timeoff and have the therapy. the family. I can also refer you to the psychiatrist to start you on antidepressant. So. greet the patient. the problem you’re having. refresh herself and that will be beneficial to herself and also. I couldn’t help thinking about that and keep on washing my hands several time and keep on wearing the gloves. she asked me whether that will be beneficial if she has some time-off from work. C: Okay. Well. the prognosis is pretty good. she wasn’t prepared for this Q) C: So. talk with your friends or husband who are supportive and caring. THEN. I will regularly follow you up and if your condition is not responding well. Finally. the RP interrupt me asking What is that problem? I was surprised that the RP did not know the problem yet coz I thought she already know her problem and just come back for follow up and asking for some time off. However. but. I just can’t help. do you think it’s rational to keep on washing the hands or this idea just drive you mad? RP: I know it’s irrational. I reassured her. don’t bottle things up. lately. isn’t it? RP: yes. but. wearing rubber gloves. I’m afraid I might transmit infection to the patients. worries a lot.definition of OCD in the stem). She was quite okay with the explanation. C: What area of speciality r you working? RP: just general (actually. It’s kinda very frustrating. lives with family and husband’s very supportive and concerns about her problems. do you have other preoccupying thoughts? RP: no C: do you used to be a worrier/anxious person? RP: sometimes. Geraldine. All the other psych Q. Also. Geraldine? RP: I’m fine. I understand. which I’ve totally forgotten. she looked happy and the bell rang. C: Hi. Candidate 2 (Brisbane) Status: Passed Same as above! . Judgement (+). I started to explain about the management plan. and then. I’d like to refer you to psychologist and do some CBT which is a talking therapy and he’ll also do special procedure called exposure and response therapy. that will make the situation worse and then. She was quite a nice lady. it’s really good that you know it’s irrational and try to resist the thought and sought some help. Then. This is just the kind of anxiety disorder and you’ve got your insight and judgement and I’d like to reassure you that you are not going crazy at all. Apart from this thought. Insight (+). no financial problems Then. (Then. C: However. I feel very anxious and frustrated about this problem and as a nurse. She is feeling anxious and frustrated and now thinks whether she can have some time off from work. how’r u going. No suicidal idea. she responded No. Task: History. she looks relieved. but. I explained her what is OCD again. Management plan Candidate 1 (Adelaide) Status: Passed I went into the room. I told her that he will create a simulative environment and make you exposed to the situation where you would like to wash your hands very much and he’ll help you to get over that situation.) For the management. which is OCD. she’s afraid that she might be crazy. SSRI (i asked her whether she knows the medicine or not and she said she heard about it) and with the combination of SSRI and CBT. I asked her whether she’s happy with the plan and she said yes. However. Also. the RP looked interested again and asked me what is that.

no acne or hirsute). I didn’t even have the chance to talk to the RP about the AN care process when she’s pregnant or didn’t have the chance to arrange the urine pregnancy test. So. Partner has previous relations. There are also no signs of pregnancy on history. I don’t know what to ask for since if it is infertility station.) No previous pregnancy or miscarriage. been regular. I started to ask 5P Period: about 13 yrs of age. I was shocked wondering whether is this station ANC or Infertility. So. ANC advice + infertility (?obesity and infertility) Candidate 2 (Brisbane) Status: Passed Same as above! I explained her also the effects of obesity especially on pregnancy and fertility. I would like to see your partner and assess him and do semen analysis. I would like to refer you to the gynaecologist to check you up and he/she will reassess you and will do some USS of the womb and some blood tests. however. the RP is not hinting at all and she just answered in very short sentence regardless of whatever I asked her and I needed to dig very details to have the information I want. Counsel the patient regarding AN care advice Candidate 1 (Adelaide) Status: Passed The stem sounded simple. I explained Life style modification. I greeted the patient and asked her how can I help her. no h/o STI. Then. BMI 40. When I walked out of this station. With this station. the bell rang at that time and I felt relief because I’m not so sure about the task and there’s no hint from the RP or examiner about my task. And also. PE: normal. I couldn’t find the cause apart from obesity. no dysmenorrhoea Partner: married. if you need to be pregnant and you’ve been trying for 12 months and no success. Also. she said she’s planning to have a joint care. I advised her to reduce weight. I asked her whether she’s pregnant now and she said no. but. I asked her whether she already checked up with hospital OPD and she said no. I advised her to reduce the weight because she falls into obesity group and the RP didn’t seem to be happy with weight reduction. knows briefly about ovulation period. stable relation Pills: no contraception and then. normal amount. however. I was pretty sure that I would fail this station. and her general health is perfectly well. However. not known to have STIs or children or orchitis or injury. She said she would like to have some AN care advice from me. I went into trouble with this station. Task: History. I started to talk to her that to have the AN care. (At this stage.AMC Feedback: OCD Station 20 25 or 30 year old lady came to your GP for AN care advice. She is wondering whether she could have your care in part of joint care with the hospital outpatient clinic. AMC Feedback: Pre-pregnancy Counselling of an obese woman . So. So. she doesn’t have other features of PCOS (regular period. Medications and also surgical methods to reduce weight. So. Normal pap smear Sexual activity about 3 times/week. she said about 12 months now and couldn’t get pregnant. I asked her how long they’ve been trying to get pregnant and then.

Myo) and the last. Then I wanted to get the correct dx by asking for PE findings but the examiner told me to stick to the task so I told the patient that I needed to examine him to assess the size. Then I explained that prostate cancer is a slow growing tumour and people dies with prostate cancer rather than died from it. I can’t believe that I pass all O&G :P. Aung and Dr. especially my study partners (Dr. Currently RACGP does not recommend screen for prostate cancer but considering you have a family hx of prostate cancer so if you are worry we can perform simple blood test (PSA) and US.. Station 5 . counsel and discuss the risks and benefits of prostate cancer screening This is my first station. PSA is a simple blood test and US just a probe to give away some signals to detect the prostate gland. but not the least. I’d like to wish everyone good luck with the AMC 2 exam. I want to thank my family and friends. I do really hope that this will be of some benefit to the candidates preparing for the AMC2 exam. which was a bit unfamiliar to me (no in my recollection of recalls). the main concern is to pass the exam. I feel blessed that I passed one Paed station. Wenzel. his GP regarding to screen for prostate cancer because his 75 year old friend at local rotary club had been recently diagnosed prostate cancer. Anyway. I had not mentioned about biopsy because I did not want to alarm the patient unnecessary. I was a bit uncertain when reading the stem. However.. He asked me what the risk for the screening.. at the end of the day. There were not questions from the examiner and the patient was happy. But.. Task: History. which doesn’t necessarily reflect how good you are in actual working environment (just reflect how well you perform in that 8 minutes of agony) and get yourself fully registered. consistence and presence/absence of nodules. The patient has some symptoms of BOO but no other risk factors except his father’s prostate cancer history. I explained to him that DRE does not hurt although a bit discomfort for him. The history showed that his father also had prostate cancer but died from a heart attack at the age of 80. CHEERS! Retest 28 May 2011 Melbourne Station 4 60 year old man came to consult you. With this opportunity. I also would like to remind you all that this recall is just written to the best of my knowledge and I cannot guarantee that the information are correct.After I got the feedback. Dr. shape.

vibration) lost just above ankle level. When I asked the patient whether she felt any pain or numbness. The patient was happy. light touch. . Task: Hx. Station 6 Middle age woman with long term diabetes recently developed numbness on her lower limps Task: Perform relevant lower limp examination It was an old recall but usually including further investigations and management.25 year old woman had a CS over two years ago now is 7 weeks pregnant. Proprioception only presented in knee level and other sensory tests (pain. I started the history by congratulating her second pregnancy. she came to enquire whether she can have a normal vaginal delivery. she did not understand or unexpected my questions but the examiner told me to carry on the examination. She then asked whether she can have vaginal delivery although admitting it was too early to discuss it. No other surgery history and contraindications for vaginal delivery. There were two tuning forks with the 256 Hz obvious on top while the much smaller 128 Hz one was covered by cotton wool and hammer so I needed to look for it. I asked for permission and said I already washed my hands as there was no antiseptic gel or tap & sink around. I finished the examination early but the examiner asked ‘what are you going to do now?’ I asked for clarification: ‘Do you mean in term of investigations and management?’ ‘No. No abnormality on inspection but no pulses in both dorsalis pedis and posterior tibial but popliteal pulse presented. therefore depending on the progress of pregnancy. just in term of physical examination’ I was sure then as I thought I had done everything in the lower limp so I answered ‘I would like to check her eyes for diabetic retinopathy. I was a bit comfortable when I was reading the stem. which was done with low vertical cut over 2 years ago in a tertiary hospital with no complication because of failure to satisfactory progress of labour. When I came in the lady was already lying in the bed with the leg exposure up to knee level. PE showed nothing except an old horizontal scar in her supra-pubic area. PE and answer her questions After went through the first station feeling reasonable ok. I then explained that there is no contraindication for vaginal delivery and point out the risks associating VBAC. then asked about the previous pregnancy especially the details with the CS.’ The bell rang. vaginal delivery can be attempted but this must be done at a tertiary hospital where emergency caesarian section facility is available and no oxytocin should be used.

reassure the benign nature (not malignancy) of the condition and offer counselling. I talked to a few of my fellow candidates after exam with the same or different role players and they all said the anxiety was the main feature so I was surprised that the feedback of Major depressive episode. how is your mood like. constipation. I was not sure about the psychiatric dx at that time as it did not fit into particular category such as major depression. The role player was reluctant to give clear answers to my questions such as “life is not worthy living. So I decided going to the safer option and told him that he got an irritable bowel syndrome. Because of the stress from work as a teacher a couple months ago. CBT. presented predominately anxiety symptoms with sleep disturbance. generalized anxiety disorder or adjustment disorder according to DSM IV criteria. kind of isolation rather than low” and libido & interest slightly reduced but no suicidal or homicidal or substance abuse or psychotic features. etc?” When asked whether he was happy with the plan of management. Task: hx dx and management I forgot this is psych station when I was reading outside the room so I was thinking what dx would be responsible to these symptoms if both gastroscopy and colonoscopy are normal. weight loss and reduced appetite. His mood is “ok. I was still worrying about his weight loss when I got in the room. diarrhea and lost 5 kg in two months. his reply was “Only when you say so!” so I did not feel well when the bell rang. he. reading materials and regular following ups. pancreatitis? liver cancer? Etc but could not come up any answer then I suddenly realized the magic 7 just before the bell rang for entering the room. now retired. I then explained the body and mind relations. Station 8 Rest station Station 9 Book case 132 (page 671 and 700) . investigations including gastroscopy and colonoscopy are normal. I took the history by asking HEADS. hurting yourself or somebody else.Station 7 50 something old man has been suffered abdominal pain. depression and psychotic questions as well as substance abuse and general health.

so once I said I would like to exam the lumber area and low limps but starting with inspection. I demonstrated the 4x4x4 method with the spacer. the female examiner did not want to give me the sheet with the results of the pulmonary function test by asking “Do you really need this sheet?” I then started by explain the test results using that sheet and some drawings but as soon as I completed the spirometry test the patient immediately asked “What have I got. I then asked the examiner whether I should show the patient how to use the medication before the 6th minutes (she did set the alarm for the 6th minutes) and she said yes. PE and Mx The patient was lying on the bed but the examiner was at another side of the room so I bended over at the bedside to take the history that was similar to the one in the book. which could be the critical error. There was a large cone shape spacer packed in a box. reflexes. . power. special tests and tone. Station 10 Book case 47 (page 222 and 248) but includes taking hx. However after asking me whether I am understand my task. I reassured her that as far as she continues staying off smoking her chance of developing cancer is reduced but I forgot to mention to do CXR to rule out that unlikely possibility if one has not been done in previous 12 months. its causes and management according to the book and John Murtagh. The examiner waved me over to another side the room then asked me what I want to know in PE. I was not sure whether I need to perform PE so I only took a very brief hx. a bag of mouthpiece resembling the empty toilet rollers and Vetolin puffer on the desk. palpation. Then the patient asked me whether she has a lung cancer. doctor and what can be done?” I quickly mentioned what the lung volumes and diffusing capacity mean then went on to explain the dx. He then gave me all the examination finding from inspection. SLRT only 30° in the left and left ankle jerk diminished and sensory loss in lateral side of left feet. I completed the task before the bell rang but I was worrying this station about the exam as I forgot to mention to do a CXR. The patient has slightly scoliosis to the left and limited movement in all direction of lumber joint with local tenderness in L5 and S1.I just did this case in the trial exam one week before the exam so I was confident with the task. movement. sensation and coordination.

I then returned to the bedside to tell the patient that he got a “ S1 disc prolapsed” and explained it by drawing a diagram. she has amaurosis fugax (curtain coming down) but no other symptoms such as verbal problem and weakness of limps. PE showed BP 150/100 P100/min but regular. Station 1 Middle age woman complained visual disturbance for three times since last weeks. I said I will give you a medical certificate for a couple days but I will see you again then to reassess your condition at this moment you are definitely off work for a couple days. this is why you need to go to hospital immediately and to prevent it happens. She and her partner went to geneticist and were told that the chance of having another Down syndrome child is 1 in 100. He then asked how long he will be away from work. He then asked whether further test is required and “No this moment. “What does 1 in 100 mean?” I explained the chance of developing Down syndrome in . Do you have any other concerns?” “No. CT/MRI of the brain. TOE and blood tests. Task: Answer the questions from the mother I was reasonable comfortable when I was reading the stem because we had argued a few times for this case since it reappeared in March 2011 exam. statin and ACE inhibitor or β-blocker. The role player asked “Will it happen again?” “Many patients who have TIA will have stokes soon after TIA. I will give you some analgesic for pain relief. thank you very much!” Station 2 30 year old woman who has an 18 months old child with Down’s syndrome now is 7 weeks pregnant. ECG. So I explained the dx is TIA and requires urgent admission for further investigations such Dopple carotid US. She has hypertension and hyperlipidaemia and on a list of medication including aspirin. second degree hypertensive changes in fundoscopy and carotid bruit. There was no questions from the examiner and the patient seems happy. you need to rest in bed for a couple days but need to get up to move around and start physiotherapy after that” I then reassured him that most of these cases will resolve completely without serious consequences. doctor. She also had an angioplasty/bypass before and family hx of DM Task: Hx PE & Management In history.

I won’t be here without them! Scenarios AMC Perth 21. It was such relief when the result came out.11. So just like Dr. . She seems not very happy so I wanted to find out what exactly her concern is. and of course. how long would he have to be off work. Very clearly hat liver disease. I finished my exam with a glass cold water and good feeling about the exam. She told me that her partner does not want to talk about this matter but she still want another baby who with Down syndrome or not. all my teachers in different hospitals. The patient wanted to know the plan from here (could he be discharged or not. I offered to see her partner. History and clinical findings given. Wenzel. Task was to explain the most likely diagnosis (biliary colic). Wenzel said that retest is not a bad result although you have to go through PTSD first. or joined consultation and simple literature to take home for her and also mentioned the support group for Down syndrome as well as ongoing support/following up. my various study partners. I would like to express my gratitude to Dr. She was a bit worry Then I explained the screening and diagnostic tests and their benefits & complications.e. whether they do not want another baby with Down syndrome that was happen in old recall. family and friends for their generous supports and ongoing assistance. i. Station 3 Rest. Task was to examine the patient. Prior to starting I offered the patient some pain relief. I explained all the possible differentials and then management.) Chronic liver disease (passed) Only real patient in exam. She was happy and no further questions.normal pregnancies in different ages and pointed out she is about 10 times higher risk than the normal pregnancies.05. written in retrospect Biliary colic (passed) RUQ pain. Everyone I know who took this exam passed. All the examiners except one who did not shave my hand and the role players except one who is major depressive are very helpful and encouragement comparing to my full exam in another place. all my lecturers in VMPF long course.

Explain management.-) Diabetes mellitus in four year old (passed) Setting in GP practice.) I did think this all the time but did not voice this to the patient. I think it was vaginitis secondary to chronic candida infection. This case is a bit of a blur. Implanon some time ago. Setting was in a GP practice. Patient clearly needed urgent referral to hospital. I failed to illicit this in the history and could not put 2 an 2 together after I was given the examination findings (“white specs on vaginal exam”) End of life request (passed) As per AMC book. task to take history and ask for examination findings. I managed to be reassuring to the patient (at least I think I was) and list quite a few causes. including what would be done in hospital and would his son need insulin forever. I made sure she was properly followed up. Asking for investigations: Urine dipstic positive for sugar. I managed to convince the patient to be admitted and mentioned in the last minute that she needs further investigations. Outcome of the mini mental test was that she was delirious (clearly disoriented). Patient appeared depressed. as I ended up telling the patient she needs a psychiatrist (which is only appropriate once an organic cause for delirium is excluded. Task was to do a mini mental test and then manage. unsure why) I clearly struggled with this one and thought I had failed. previously no problems with intercourse. I think I could have handled this case better. Croup (passed) Fairly straight forward. Dyspareunia (passed. Father asked a few questions. I could not remember all causes and if it was necessary to further investigate. . It must have looked quite bad . I completely forgot to ask about drug history. Young recently married woman. young kid presents with bed wetting (if I remember rightfully). now dyspareunia. Through history it becomes clear there is polydipsia. exactly the same. Question from the examiner: Could it be something else? Delirium (passed) Aboriginal woman refusing dialysis.Clinical and U/S confirmed IUGR (passed) Explain causes and management.

The dad asked me but what about his “glands”. Turns out patient has sister with heart trouble. After making sure the patient had adequate analgesia I explained further management (my approach was CT and then LP. Drug reaction to Amoxicillin on a background of likely glandular fever. Recent procedure mentioned in stem. Took a psychosocial history and asked for depression. Task was to chart growth charts and explain significance to father.Headache acute (passed) Setting ED. I called it that.. patient with bloating. but would refer her to a cardiologist if she wanted this. I further made clear. From the history it was evident that the Kid loved Take Away Food and had no exercise (preferred computer games). Image shown showed maculopaular rash. Not sure if I was required to do further testing. unsure why. Exam: BP normal. After finishing the history and examination. some neck stiffness. Febrile. . including sisters illness. unless there were significant delays to get tests organized). I think it would have been fairer to have multiple slices of a CT to be able to localize neighbouring structures (I would have been able to spot the spleen). Child had gained a lot of weight and was above the 95% percentile (prior was normal). Sore throat and rash (passed) Take history and explain reason for rash. Taking the history it became evident. Antibiotics as soon as possible after tests. History photophobia. My diagnosis was meningitis. no cause found. that patient had recently undergone ERCP. Explained it is highly unlikely this is somatic chest pain. so the weight gain was probably life style related. that I think a lot of what was happening in patients life was to do with lots of social stressors. Otherwise normal neuro exam. Obesity (passed) GP practice. Pancreatic pseudocyst (passed) GP. I suggested a referral to a dietician and lifestyle changes.. No rash.. (I assume I was right given I passed). onset after taking Amoxicillin prescribed for sore throat by GP. I thought it could also be an enlarged spleen. I passed. You the Gp notice the child is more than chubby. I feel a little ashamed to admit. the examiner asked me to interpret a coronal CT image which showed a LUQ collection. Routine follow up for asthma. Psychosomatic chest pain (passed) Lots of investigations done. Patient had sudden onset of headache. that I did not click: ERCP + collection in LUQ = Pancreatic pseudocyst. Diagnosis.

Transient visual loss due to thrombembolism (passed) Task take history and examine. even though I seemed to remember pregnancy was not possible. How do you manage (do you give hormones. especially about pregnancy. Thus far not too hard. Task to take history and ask for investigations. Turner syndrome (passed) Primary amenorrhoea in a 18 year old. . But the big question is. I thought maybe there was a new fancy way of hormone treatment to facilitate pregnancy. Appearance scribbled down on a piece of paper (as clearly the role player did not look this way): Short stature and something else. can a person with Turners become pregnant?). Lets put it this way. how do you explain Turners to the patient. Everyone do not forget to examine the cardiovascular system after doing your neuro exam. No webbed neck. I do not think I came across cleverly. I was not sure.

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