aid 4 Chuck fp af ie pr pacl sce AT ranl 4 ‘qpote * aR mw Row @ Clinical Exam 26/02/05 Melbourne 3 My Exam was in the afternoon. After waited in the area about 1 and half hour, { started with Dr. Marshal (the nice dr,in AMC video with hand examination) . x e twas a middle aged women who had duodenal ulcer perforated. Op was done * ¢ 6 hours ago without complications. Now pt. has no urine. U&E was checked - L : Before op which was nomal, Your tsk please exam pt and write done your - Svomb0i Cuey Fornin FE Me pubs, enka ane handbook er ea Iwas a bit nervous. Dr marshal asked me if T understood my task then introduced me to the pt. Pt looked real. Obesity. With GI fube 600ml brown flisid and iv line 4 “was the second S00ml glucose. No catheter. After rapport, I started to do J abdominal exam: Bladder percussion was empty. wrote 0.9%n.s. 500m! bolus and same 500ml continue the next hour. said I want to put catheter in. He asked - . when? I said now. Ok. I was sent out earlier. lovew over ee hour - Mc handbook ‘A:man with one MCP joint pain, no Hix of trauina, He'drinks 2-3 cans of beer everyday. OFE it was welling snd sed and texidemes, ‘Your task is Ix and Mx. Ar fomore Hx and Ex ed eso firsh {trtonp term - = Ae vo} Actually the pt had no joint show me. I said fiom the story and Ex I suspect you Be NSH On . had Gout. Then T explained what was gout. The examiner asked me what Ix Inced@"*¢’ ° & ‘ to do; Isdid FBE,U&E, LFTs urate x-ray etc. He asked what was the treatment, (B? Col Ch '¢r'x Pt said Thad twice this pain. I don’t want third time. Sure I said, Toan give you anvil ise gashix medication which can reduce the urate in your blood, and I will give youa pain. aleuhalexess killer ag well. The Examiner asked me what medication! Before attended the 8 nat wusrne, exam, on¢ of thie dr told us that in her exam all she mentioned just medication. Nop 2a! drug name ard dosé. So I didn’t try hard to remember all the medications, I told Fomipsn the examiner I cquld not remember. He let me go eatlier too. Outside the door, 1 ~ . + heard they were falking inside. “I know she lmows, she just couldn’t say it” This “is rmy worst station ii the exam. i don’t think I can pass because at very beginning . fhe AMC lady said you are asked to leave earlier mot mean you can pass this station. “| x — Sina’ od f aL omicnes 29 - A young inan was sent to ED by roommate because of cotta. The roommate’ doesn’t know him well, Pt. airway clear, breathing good, BP stable. Your task is assess pt GCS, Bx and give examiner your Dx. ~ L Lknocked i in, a young man was lying there. I asked is ABC already checked? es”. My GCS was 9. All cther Ex was normal, After mentioned cervical injury, ” the examiner said suppose no cervical injury, I checked the neck stiffness. It was ‘hve. My DDx. were. Meningitis; SAH, and drug abuse, post epilepsy, and _ Bypeslyesomis . “This station is Alopecia areata. In front of the dodr was two photos of a boy. But it was a'35 yo female. With several patch of hair loss, And biow as well. ‘Your task is Ix, Explain and Mx., Nea ste RH 5 oe Che . ; 094 et —exeg aah drwyys personne wiry ogan spect fie aspremanue . ee pt " see pen whens Task bkaminer if I take a hae will it looks like “1” ? Exuminer couldn't understand me. I draw’a picture, Thei I said pt need wood’s Tight test to distinguish with'tinea infection. What else? The examiner asked. 1 don’t know ‘what she want. So I said I need send pt to dermatologist do Biopsy to confirm the Dx but 1 ama quite confident to say it is AA. How about thyroid? She actually is giving me clue. Ok, Isai, thoy are all autoimmune disease, It is possible. I can do ‘a TET for her. It was a difficult station, everyone felt bad. a ‘A rotived mian with 6 months pain in shoulder and neck arid miomizig stiffness: ‘Task is Hx, ask examination findings and Ix Dx. . ee 1n Hx, pt has this pain always there and moming stiffuess. Also weakness.No closaly we blurred vision and headache. O/B, shoulder and neck had fall range of movement cali be ty “but e bit uncomfortable. I asked ESR, it was 110.1 got Polymyalgia cheumatica straightaway. They are happy with my Dx. The examiner asked me what else Ix I want to do? [said X-ray, to DD with OA, Cervical spondylosis. Xray is normal. ‘What else? RF? Normal. what else? Ido a ophthaloscopy: “if pt has no blurred: eg) L vision, will fundi change?” he asked. No, I said. Ok, what else? I don’t now, I See ten oe mvc png {Te bllzang- sou be able tas t R ‘he wants? I do: ‘know even now. Mas e TFT? Mast cule “Sole iaftehen s 20 SLE, PAN BER a Apher" -€8 7 Appendicitis. The examine? a adh ly to pass everyone. Twas delaxed Se Temi eal : . ; middle aged man with tiredness and utine probiem. Come te:your GP clinic - Your task is take a Hix, asi Ex finding and Dx. [remember no Mx required. - * Before I went in, I thought it was DM, but it was a prostate hypertrophy. PSA was 2 Ronnal.’He has to get up at night 2-3 times to pass urine. He is not on any -modioation. PR ex is enlarged prostate, with middle groove intact, itis benign, Although pl’s father had prostate cancer at age 80. I still talk with pt some Mx, - When the bell rani, pe said 0 I don't have cancer. No, you don't. Ist: : Lo pe ‘was a palliative care station. Ptis 45yo man who had bowel cancer op 2 ‘years ago: Now coniplain pelvic pain and a lump there. He is taking Panadol Which was not effective, Liver is clear. Task is your Mx. v1 showed my! big ‘sympathy aid offered morphiue. ‘Also mentioned social help. The roll player was a young man, looked very distressed. He asked how long I can live? It depends..1 said. I will refer you to oncologist who is cancer specialist. They thay use radiotherapy for you. Which only cau relieve your pain but nut suve your life. 1 finished before bell rand, theri Ilooked at examiner. He said, ol, that is the end of this station. . on lady with 6 wooks old bby had ear problom after attend postuatal cls ECG was done only sear, Task is focuséd Hx, explain your Dx. And | Task is focused Hr, ox ae .ope IG itwas Panic attack, the lady also said she bad agoraphobia, She is not depressed. rape Suicidal idea.or wants to kill the baby. Cope well with husband. Lnefe hee to Psychiatrist for further ‘treatment. hen tale with the lady, ask the mental state ex questions. The Examiner © peat interrupted me said her mini meatal Bx is normal when {tied te tex hes ot Sake. com memory. I should ask her psychiatic hx, but [forgot totaly. The lady : “complain the neighbor always talk actually no onelive in that rosan She too. SomPlain se couldn't bear the mass inher flat. Other poople got OCD fom this va ° Prose’ she continuously to clean up the room, Tdidn't My Dkis Schizepbeena 7 {or this long Hx. And DDx are organic problem such as CVD or akohat awa although she denial alcohol drinta _— = So, NF si pinion 0 - win eg tah pin pain, T3bk is take oy @ brief Bx and Ix and Mix Se , SS a . j2:ke4 vital signs frst which was stable. Baby's heart was good. Thea T asked 6 how much’blood, she said like heavy period -Tt The BP now is 160/90, asked GCS, the Examiner said we never use GCS before. Ok I said, what the medication I am giving her? “ You are the Dootie!™ thiey answered me. I turned to thie husband to explain. [said your wife had eclampsia, it -1s an important situation. I néed call-help and transfer her to tertiary hospital. He asked why bis wife had this? 1 said wel, it was diac to high BP, and PIE is sac of - the complications of pregnancy. About 3-8% women will have this complication, / alrendy used medication for he... Examiner asked me what medieaiwe 1 said” -Magnesiuim Sulfate to prevent further fits and b-blocker for BP, ‘They seemed | | Satisfied with my answer. Pe 13/Breast feeding consultation. The lady with 35/40 Pregnancy comes ask breast feeding. . feeding and bottle I feel-knowledge here is not the most important point. We all know breast feeding “is good, The point is how to say it ‘with passion!