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Station 1

Kate, 77 year old lady presents to emergency after being found collapsed on the floor of her home.
1. Please take a directed history (6 minutes)
2. Please look at her ECG and CXR (2 minutes)

Station 2
Caesar is a 64 year old gentleman who you see on the ward. Past medical history relevant for been
stabbed in the back by his friend Brutus.
1. Please perform a neurology examination of either his upper or lower limb (6 minutes)
2. Please look at his examination findings and attempt to localise the lesion and suggest a Dx
(2 minutes)

On Examination:
UPPER LIMBS
Right

Left

General Inspection

Laying still. Scar mid central chest posteriorly. Suprapubic


catheter present.

Inspection

NAD

NAD

Tone

Normal all joints, no clonus

Normal all joints, no clonus

Power

5/5 all joints

5/5 all joints

Reflexes

Present, normal

Present, normal

Coordination

Normal

Normal

Sensation

Intact all modalities

Intact all modalities

Right

Left

LOWER LIMBS

General Inspection

Laying still. Scar mid central chest posteriorly. Suprapubic


catheter present.

Inspection

Scar from grt saph vv graft.

NAD

Tone

Hypertonia all joints, clonus


present

Hypertonia all joints, clonus


present

Power

1/5 all muscle groups

1/5 all muscle groups

Reflexes

All absent. Plantars up.

All absent. Plantars up.

Coordination

Cannot assess due to weakness Cannot assess due to weakness

Sensation

Anaesthesia all modalities


through entire limb

Anaesthesia all modalities


through entire limb

A sensory level was found approx at level of umbilicus.

Station 3
Steve is a 75 year old gentlemen who presents to your GP clinic regarding return to driving after a
heart attack 1 month ago. His ECG has normalised since his AMI.
1. Please counsel Steve regarding return to his work. (8 minutes)
An extract from The AusRoad guidelines for Assessing Fitness to Drive is provided below.

Station 4

Emma is a 19 year old lady who presents to emergency after episodes of prolonged vomiting and
haematemesis after an alcoholic binge.
1. What are some differential diagnosis for haematemesis? (2 minutes)
2. Please look at her investigations and interpret accordingly (6 minutes)
FBE
Hb
MCV
Reticulocytes

101
93
4%

Decreased
Normal
Increased

WBC
Platelets

9
390

Normal
Normal

Film

Polychromasia

UEC
Na
K
Cl
Ur
Cr

137
3.2
77
19
89

Normal
Decreased
Decreased
Increased
Normal

pH
PaCO2
HCO3

7.51
66
18

Increased
Increased
Decreased

Bilirubin
AST
ALT
ALP
GGT
Albumin

11
20
21
60
211
40

Normal
Normal
Normal
Normal
Increased
Normal

ABG

LFT

Station 5
Will is a 47 year old gentlemen who presents with a history of chronic diarrhoea.
1. Please consent him for a colonoscopy. (4 minutes)
2. Please look at his pathological findings taken from the same patient (4 minutes)

Patient Instructions:
Station 1
Patient:

You have third degree heart block. Not really much symptoms; maybe previous
syncope, dizziness/presyncope. Make it up (it'll be like testing how much you know
about the condition)
Past medical history of a few AMIs, CHF, + make up others
Make up the rest.

ECG

3rd Degree Heart Block (?cause for syncope; Stokes- Adams Attacks)

CXR
Pulmonary Oedema/Congestive Heart Failure
_______________________________________________________________
Station 2
Please kindly allow them to examine you :)
Examination findings, I was going for complete transection of the cord, approximately around
T9/10.
______________________________________________________________
Station 3
Patient:

You want to drive around in your private vehicle. You had a NSTEMI and have been
drugged up (aspirin, beta blockers, ace, statin, others if you want).

Take an occupational history? Practice makes perfect.


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Station 4
I was going for a Mallory Weiss.
Normocytic anaemia (although I doubt they'd be that anaemic; ?not enough blood loss).
Reticulocytosis (Incr number and polychromasia)
Prolonged vomiting causes hypochloraemic metabolic alkalosis w respiratory compensation (loss of
HCl) and loss of K+
GGT increase from alochol?
Urea:Creatinine high from upper GI bleeding (?may not happen this quickly)
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Station 5
Consent general things; introduction, procedure, benefits, risks, assess understanding, actually ask
for consent, etc.
Pathology:
Image 1:
What I suspect is the small intestine (?more pronounced folds, smaller calibre? I really can't tell).
Area of normal mucosa interrupted by areas of ulceration producing 'cobblestone appearance.
Ulcerated areas have transmural inflammation, especially seen when compared to wall thickness of
adjacent to normal mucosa. Ulcerated area seems to be narrower; ?stricture.
Impression: Crohn's Disease of small intestine as suggeseted by skip lesions, cobblestoning,
transmural inflammation and ?stricture.
Image 2
Histological H&E stain looking low powered view of cross section of what I suspect is the large
bowel (due to lack of villi, crypts, etc.).
Low power view shows diffuse basophilia? (increased blue/purpleness) of the tissue, especially
mucosal and submucosal which seems to be secondary to infiltration with numerous cells which I
suspect are lymphocytes; chronic inflammatory cells.
Not sure if there is a fissure or not.
Impression: Crohn's Disease ?of large intestine as seen through transmural inflammation
(lymphocytic invasion), particualrly of the mucosal and submucosa.