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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
Inspection
NAD
NAD
Tone
Power
Reflexes
Present, normal
Present, normal
Coordination
Normal
Normal
Sensation
Right
Left
LOWER LIMBS
General Inspection
Inspection
NAD
Tone
Power
Reflexes
Coordination
Sensation
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).
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.