@marimphil wrote:
THERE MIGHT BE SOME TYPING ERRORS SO BEAR WITH THE TYPIST (GOOD SAMARITAN FROM MELBOURNE )
(Perth Oct 2005)...
1) 60 y/o man comes to you with severe chest discomfort, take history..and present to examiner..tell examiner what investigations...u would do...Examiner then gave me a ECG to read..the patient also said that he was recently injected with some steroids for joint pain..i.e pain could be ulcer related..as a differential ( i think...there was ST elevation in leads I II and AVF ...he wanted to know what type of infarct..i wasnt sure..inferior infarct)
2) Mother comes to you to see about her 5 yr old son who is fine but with blood test showing glucose at 21 and some ketones in urine...discuss short term management(need to be admitted to hospital ..) and long term management ( explain about diabetes and care needed with it..) with mother..
3) 50 y/o man comes to you complaining of on going hoarseness for the last 3 weeks..take appropriate history and discuss investigation and management with examiner
4)a man comes to you (emergency department doctor) saying that his wife who recently gave birth has started to act strange..accuses baby of being evil (child of satan)..wants your help..
5) a married woman mid 20's comes to you (GP) with 8 weeks of amenorrhoea and suddden onset of period..take history and discuss with patient..(allowed to ask examiner for investigations) diagnosis andmanagement
6) 60 yr old woman comes to you (GP) with feeling unwell, dull pain in left lumbar region...take history and ask examiner for findings..discuss management and diagnosis with examiner
7) a father comes to see you (GP) about his child (i think 5 yr old child) who has a known murmur and is well, was advised by previous GP that the murmur is benign and to have annual check up...the father is to take the son to the dentist next week.(murmur is 4/6, parasternal heave,)..child is well with no complaints. Discuss diagnosis and management with patient.
8) a man in his 20's comes to see you (GP) about a tense scrotal swelling in his left testis. it is transilluminable and you cant feel the testis separately.Discuss investigations and diagnosis and management
9)a lady comes to see you (GP) mid 20's, she suffers from epilepsy and is on phenytoin..has been seizure free for the last 2 years .She is keen to get pregnant and would like to discuss this with you.you need to give her pre-pregnancy counselling
10) a university student comes to see you(GP) ..finding it difficult to concentrate on studying always checking her work..and submitting papers late...Please take history and discuss differential diagnosis and manageemnt with examiner
11) A man comes to you (GP) with a flu like illness and a rash on his chest..he also has palpable lymphadenopathy and hepato-splenomegaly..take history and disccuss potential diagnosis and management of this patient(going in i thought this might be epstein barr, the catch here is that this man is gay, and that this could potentially be HIV)
12) a woman comes to you (GP) with a complaint that her baby keeps banging her head in the cot when she sleeps at night.ask examiner for investigations (all normal)...
(this one was tricky..i had no idea why this was happening from the history , her partner left her and she has no financial support..so i thought a cry for help.. maybe...once i finished exam and checked up there is a thing called benign rolandic epilepsy that happens only when babies sleep..so i feel i failed this station)
13) a woman comes to yo(GP) u after you referred her to gynaecologist for menorrhagia (hysteroscopy, pap smear..normal)..now suffering from menorrhagia again ,Hb 70 ..discuss management with patient
14) a man comes to you (GP) with lower left quadrant pain..feeling unwell please perform abdominal examination...and discuss management with examiner
(so ur standard abdominal examination...hands,face,abdomen..the actor was tensing up his abdomen ..so when i started his deep palpation i couldnt get him to relax i stopped and told examiner this man has a rigid abdomen i explained what i would do in terms of completing my examination but there was no point as u cant palpate anything with a rigid abdomen...and he needs hospital admission with surgical evaluation..disccussed this with the examiner)
15) a woman postmenopausal comes to you (GP) after having lumbar xrays( vertebrae fracture) and dexa scan showing -3.0..i.e osteoporosis..take appropriate history and discuss diagnosis / differential and management with patient
16) a woman comes to you with a complaint of nervousness ..take history and ask examiner for examination and explain to patient diagnosis and management.
1) myocardial infarct
2) diabetes
3) lung cancer..hoarseness of throat the cancer has invaded recurrent laryngeal nerve..poor prognosis
4) peuperal psychosis
5) spontaneous abortion
6) UTI/pyelonephritits/cholecystitis
7) this murmur..could be VSD..realy not sure recomended peadiatrician to see since patient recently moved here (for specialist assesment..made a mention about prophylaxis for endocarditis)
8) orchitis ? cancer...
9)Would need to stop phenytoin / change but advised discussing with neurologist and getting his opinion ..and all the other prepreganancy stuff..immunisations/alcohol/smoking /etc
10) OCD
11)HIV
12) ? rolandic epilepsy / social worker needed
13)OCP pill for temporary management , will probably need transfusion since she was symptomatic, refer back to gynae
14)acute abdomen..diverticulitis.IV antibiotics vs Surgery
15)HRT,calcium,vit d..suppose potential differential would be mets to bone / multiple myeloma but she had no hx of cancer
16) hyperthyroidism..goitre
Clinical exam April 04 Perth
1 a mother comes to you regarding her 8 yr son’s deteriorating school
performance of last 6 month; take the history and dd, diagnosis, child hood depression, phobia
2 21 year uni student deteriorating performance at class the to delayed
submission of assignment for last 3 month OCD
3 48 year old man old CIA/FBI following him co dizziness after taking
riseperidon 2 days ago, take focused history, management, side effects, anti depressant
4 48 year old female BMI 27, smoker, came for endoscope report, shows reflux oesohpagitis, examine, management
5 55 female had difficulty swallowing was treated with omeprazole, felt
better with it, now it does not help; now difficulty with solid, swallowing
last week, take the history, investigation, management, ca esophagus
6 45 male his brother had bypass surgery came, for check up, assess the risk factor BMI 28, smoker, office job and council the patient, man died of heart attack at 55 years
65 of female post op day 5 L THR c/o chest pain SOB on heparin 500 u bd, post op task, take the history, dd, investigation,
8 28 year female with a history of 3 year, amenorrhea, patient asked will I be pregnant, take the history, ask examiner test result, management agree
9 37 female primigravida 8/52 amenorrhea 2 wks history of vomiting take the history investigation, management, count the patient don’t forget about Downs syndrome
10 26 female 10 days post parturition of 2nd normal delivery time and with sudden onset of vaginal bleeding 1 day history. Take history, management, patient wanted to know do I need blood transfusion
11 40 year female, found a murmur 2 yrs ago during a routine check up,
patient asymptomatic, since she was diagnose with murmur, comes to you, examine the CVS and tell the findings, give running commentary- MR
12 23 yr female with history of dry cough not relieved, take the history,
examine, giving running commentary, examiner asked what investigation, you will do and the management
13 42 year female with history of leg pain when she walks 100 meter relieved by rest, examine the leg, give running commentary, examiner asked what test you will do
14 19 female, single mum with her 6 month old baby, has fever, vomiting,
irritability baby was seen by colleague 2 hrs ago found swelling R humerus, and bruise on cheek requested x-ray, showed spiral fracture R humerus, mother came to you to know about x-ray, task explain x-ray finding, management
15 mum came to you with her 18 year old girl who has T 38, urine shows
numerous leucocytes, child is otherwise ok, take history management mum wanted to know whether I am going to give antibiotics
1 primary postpartum hemorrhage
2 pre pregnancy advice for a lady who had DVT and PE postpartum 2 yrs ago
3 missed abortion diagnosis management ant treatment
4 croup diagnosis management
5 functional constipation in a 6 year old boy diagnosis and management and
history
6 behavioral disorder ADHD
7 mumps orchitis diagnosis management
8 Bells palsy management
9 hepatitis c management
10 herpes zoster diagnosis and management
11 dizziness in schizophrenic on risperidone management
12 PVD examination and diagnosis
13 loss of voice in a 17 year old history
14 acute abdomen exam and diagnosis
15 distal humerus fracture in a 11 year old diagnosis management
16 Tiredness and weight loss in a 60 year old
Clinical exam in Sydney stage 2 may 2002
1 F /30s acute appendicitis diagnosed by an intern occupation lawyer very
busy management: d/d what if dx is incorrect, types of appendicitis,
possible findings of chest x-ray in appendicitis.
2 M/50s post op anuria possible causes, p/examination, review U/S, fluid
chart, then management, write down your prescription
3 F/20s mother died of heart attack since then she has developed chest pain
palpitation circumoral tingling sense, spasms of hands, clinical management,
hypocalcaemia clinical management.
M/20s injury to left knee relevant history p/ exam, then I was asked what
structures are damaged.
5 F/20s family history of breast ca the patent has cyclical mastalgia,
reassure, primrose oil, management, included interpretation of u/s FNA as
well as explanation to patient, is this condition related to Br ca (danazol
bromocriptin tomoxifen, t4, FNAB c5 ca c4 suspicion/ probable ca c3
suspicion/ probably benign c2 benign c1 inadequate sample
6 F/20s regarding alcohol drinking e peer performance in the work place,
history, management, short term and long term problems, safe level of
alcohol drinking for women
7 M/50s black colored patient with a long history of alcohol drinking p/
exam this is a real patient, elicit & demonstrate relevant physical finding
alcoholic cirrhosis on eye exam nystagmus on lateral gaze was revealed
8 M/20s with occipital injury do cranial nerve test
9 M/30s with pain on the soles of both feet
History, pt management, x-ray, plantar fascitis
10 M/20s DVT developed following a long hauled flight, explanation,
management, risk factors, prevention, treatment, then write down your
investigations prescription on day 1 in hospital heparin 15000 unit /12 hrs
via pump compression, uss
11 M/20s presents with pain around the wrist management, history and
pat/examination revealed that the patient has De Quervain tenosynovitis
physical signs the tendon involved
12 M/40s with IDDM narrowly escaped a car crash this morning he as and
insulin injection this morning as usual without taking meals because of
running out of time management
AMC clinical Melbourne may 2005
1 History of 3 year old boy of viral infection 2 weeks ago blood result
pancytopaenea.Management, talk to father
2 Henoch scholien purpura, 5 year old boy, photo shown, urine protein ++,
rbc++,
Management.
3 SIDS, baby 3 month old died, history of viral upper respiratory infection
2 days ago, talk to the sister of baby’s father.
4 24 weeks ADG, 20 years old, lives 80 kms from the city very much worried because her first pregnancy was OP position with prolonged labor, delivered by forceps, now she is very worried, history and management
5 20 year old lady, 20 weeks pregnancy, had previous history of herpes
simplex, now she has developed ulcer on labia, not much painful, history
management of recurrent herpes simplex
6 a lady delivered a baby 4 days ago, now developed fever, mastitis, history management investigations.
7 20 year old man, wanted to lift a very heavy object, to sever pain in his
shoulder task examine R shoulder, history for diagnosis of rotator cuff tear or shoulder dislocation
8 40 year old male going to overseas, gp found a heart murmur, examine the CVS of patient and comment to examiner
9 a lady 60 year old, had bowel operation 6 weeks ago, now suddenly she has developed R sided pluritic chest pain, tasks describe cxr and management pleural effusion
10 40 year old has action tremors for last 20 years, father had Parkinson
disease, task history, management, investigation, diagnosis, benign
essential tremor
11 25 year old had mump 2 weeks ago, now he develop orchitis, his sons also had mumps, he is very worried about orchitis, future fertility, sexual life,task, management worried about 3 years old son because he might get mumps
12 a unistudent checking his study all the time, cannot study, failed in the
examination d/d OCD, delusional disorder history d/d talk to examiner
13 a 20 year old lady came back from overseas long hall flight develops pain in R leg, uss, DVT task, history, management
14 49 year old male complains of pain in R upper abdomen with rigors and fever, and mild jaundice, tasks, history, management, investigations,
diagnosis, ascending cholangits
15 a 50 year old lady had colonoscopy, showed colonic polyps, with mid
dysplasia, which were removed, task follow up, talk to patient
16 daughter of a 65 year old mane with Alzheimer’s disease comes to see you, she is very much concerned about his father, he lives alone, impairment of cognition, is wandering around houses, council daughter about the management of her father
Sydney may 2003
Station 1 h/o DVT management write prescription down
Station 2 low back pain examine lower back
Station 3 young female on ocp, bp, 160 /105 management
Station 4 fibula fracture management
Station 5 rest
Station 6 renal colic management
Station 7 Woman young excessive alcohol for last 6 month dd post traumatic stress disorder, depression, alcoholism
Station 8 examination hand H/o arthritis
Station 10 young female patient comes to you in tell her about the report
FNAC shows papillary carcinoma of thyroid
Station 11 young male patient with history of asthma comes to you because he bad allergic reaction atopic dermatitis management
Station 12 55 yr old male patient comes with long standing COPD council him about management, also instruct how to use of bronchodilator inhaler
OSCE’s
1.8 yrs old john come to see you and his mother for last few days is
complaining of bad pain all exam
Urine NAD
Task relevant history
Discuss with mother about diagnosis and management
2.65 female come to your practice for her x-ray report. x-ray shows
compressed fracture T11 no neurological deficit x-ray provide
Task: take relevant history
Discuss with patient about x-ray finding
Discuss the management with the patient
3.You are working in emergency department in a tertiary hospital a 32 week primi-gravida presents to you after a MUA no injury found
Task: take relevant history
Ask examiner about exam investigation he will only tell you if you ask.
Discuss your management with the patient
You are about to see a patient in ED brought by friend from hostel who
has found him unconscious. He has just come to the hostel. The person who brought him does not know him at all
Examination time 4 min rest 4 min for d/d and inv
Do appropriate e exam narrate it to examiner or tell him at the end of exam
Tell the examiner d/d
Tell the examiner appropriate investigation and why you’re doing it.
GP 23 year old accountant comes to you has found elixir of life wanting
to tell it everybody cam to you so that you can help him to distribute his
elixir of life
Task: take relevant psych history
Tell 4 dd’s to examiner
Management to plan
6.4 yr old boy brought in by anxious father the boy the father both had
lower resp tract infection 10 days ago now father is ok but the boy is
coughing for last 10 days. He has a 2 yr old son also. x-ray, spirometery
and chest x-ray and sputum Normal
Tasks take relevant history
Discuss management with father.
32 years old women comes to you of SOB and palpitations for last few
weeks she has been involved in MVA few months ago General examination
Take relevant history as k the examiner examination finding discuss the
diagnosis and management with patient
28 year old primi-gravida 12 weeks pregnant work as prostitute came to visit you seen by your colleagues 1 week back and done some inv she wants to know the result
Take relevant history ask the examiner about exam he will only answer if
asked. Discuss management with patient.
ED 20 year old man come to see you with rash snap shot supplied he was seen by a gp 1/52 back of sore throat
Take relevant history 4 min
Ask examiner about inv and exam he will only answer if you ask
Discuss your management with patient
36 years old lady long standing mild hypertension and type 2 DM comes to you for visual loss temporary on rte y. she is on perindopril 2 mg glicalzide
Task: take relevant history 23 min as the examiner about the examination finding 2 mins
Ask the examiner about examination if discuss tithe patient about what
investigation you are going to do and management plan
11 4 years old lady come to you found to have fist blood sugar 15 bp 150/96 mild obese
Take relevant history 4 months
Ask the examiner about exam finding
Discuss with patient inv and management
12 40 year old man comes to you with cp which wakes him up at 2 am
Relevant history ask the examiner about examination
Discuss with patient about inv
13 40 year old lady comes to you with PR bleeding exam 2 hemorrhoids
Relevant history
Discuss with patient about her further management
14 anxious mother came to you because her 4 years old son in bed wetting
general exam
Urine nad
Relevant history
Discuss management plan with mother
a young lady come to see you she is going to Europe for a month long holiday on her way she will stop over in Thailand for 2 /5 days
Task discuss immunization answer her questions
Anxious mother came to you with her 12 years old daughter she has
started her periods which is to going to last 10 days
Tasks relevant history
Ask examiner about exam and invest finding
Discuss with mother about management
Adelaide 2001
Management DVT and anti coagulants knee examination of a rugby player
injured
Management of urinary tract infection and write a prescription
Appendicitis operation advice
Carpal tunnel patient examination and causes of thenar muscle atrophy
Examine abdomen liver cirrhosis
Pain right upper quadrant Examine abdomen us supplied diagnosis gall bladder
stone cholelcytitis
CVS examination and pansystolic mummer
Or tem r
Advice HRT effect on br cancer
Int claudication examiner and manage
Sydney 2001
1.Examine CVS VSD v wave r and PS heave pansystolic murmur tapping apex ,diagnosis mitral regurge dd MR
2.Examine GIT nad history varices hepatospleenomegaly had chr Liver disease
3.Young girl high blood pressure history investigation and management OC pill and smoking most for cv risk, stop ocp advice stop smoking
4.Renal colic diagnosis explain investigation management ivp given and stag horn stone
5.video tape 3 min watch patient and mental exam
dd anorexia bulimia nervosa
6.Examine comatosed patient
7.History and management rectal bleeding patient 23 history father died of bowel cancer 57
8.Picture of left supra clavicular node exam and investigate report given FNAB squamous cell ca dd skin GIT malignancy lung ca
9.Wrist injury with tile cutter examine hand diagnosis ulnar nerve injury ,
tendon - branch flexor carpi ulnaris injury
11.Examine breast lump formal breast examination in a normal acting patient dd fibroeadenma now cyst cancer history breast cancer family ovarian cancer
12.Examine diabetic patient for review 6 months and mention any bruit neck chest heart kidney abdomen of AAA then I did p vascular examination Left limb then I did neurological examination on Left limb
13.Exam abdomen and history for right hypochondrial pain acute cholecytitis
Melb 2002
1 55 65 year old male drinking alcohol in past examine him examination
revealed a large distended abdomen bulging in the R side with old scar. What is the diagnosis?
2 32 year female picked or pulled up heavy things1/52 ago now she has got shoulder pain examine and diagnose
3 32 y female past history of knee trauma medial side with tenderness
examine diagnosis and management
4 33 year old female police officer refer to you for diagnosis what is wrong with her She is not good in her job always drinking drowsy not doing her job well drinking 8-9 glass wine every day management otherwise losing her job do u get withdrawal if u don’t drink
5 45 y old IDDM 3d episode of hemiplegia and slurred speech
history, management TIA
6 32 year old female has checked BP 150/110 she is on the pills management (pill e BP)
7 lump in the back of her hand diagnosis and management gangelion breast
8 45 y of female had leukemia 1 year ago had chemotherapy now `10% wbc.She is crying refusing chemotherapy management
9 cxr diagnosis pneumothorax history 3 yrs ago which had was running p/w SOB
10 28 year old male after death of father not sleeping diagnosis
Management
65 years old male with back pain x-ray shows t12 density decreased BPH 32 year ago operated smoking
35 year old male testicular swelling 2 weeks ago
Young man severe asthma attack
Migraine
Difficulty of urination
50yral old male good health father died of heard attack worried take
sleeping pills before to see you BP 150/89
7 60 year old male with heart failure and AF on warfarin for 3 months has
had cholesterol 6.5 and on lipid lowering tablets he was also on digoxin
tablet INR 25. Today planning to have a long flight travel worried to have
DVT candidates have been asked lots of question regarding anticoagulation therapy complication contraindication interaction with other drugs etc you are not allowed to ask more questions
8 20 -25 year old female notices an upper outer quarter breast lump the lump was 2 cm by 2 cm non tender lobullated firm she felt it about 2 months ago no significant change in the last 2 month a few small ancillary lymph nodes palpable last period 3 weeks ago no family history of breast cancer on OCP discuss your management plan of the patient
9 65 year old male ultrasound found 6 cm 2 week ago and 7 cm today of his abdominal aorta please discuss his management plan
10 4.45 year old male complains of chronic abdominal pain, endoscopy found duodenal ulcer H pylori and discuss your management plan
11 50-60 year old female who underwent laparoscopic cholecystectomy a week ago developed sudden onset to breathlessness 2 hours ago in ICU now suspected as having PE x-ray, ecg and lung scan shows V/Q mismatch she is on O2, IVF, heparin informed the surgeon who is on his was asap non smoker no previous medical problem once drinker married with 2 children lives close to husband the husband very distressed wants to know how is his wife is it serious condition upset that the surgeon did inform that it couldn’t be a complication of surgery wants to sue the surgeon. Also discuss how could it be prevented in the future
Acknowledge his distress risk factor prognosis anticoagulation warfarin INR precautions monitoring prevention
12 42 year old man married with 2 daughters school teacher occasionally
takes alcohol no smoker found to have BP 160/95 mm with he win tot donateblood at red cross camp to see you a gp clinic with BP lying 165/90 and standing 150/85 fundi exam normal CVS exam normal urinalysis normal no secondary cause of hypertension ,glucose 6.8 (not fasting) cholesterol 5.5 (not fasting) ecg norm BMI 31 24 hour monitoring 160-185/90-105 family history father had coronary angioplasty mother type 2 diabetes and angina you see him for review discuss management
12 50 year old male had colon cancer diagnose with colonoscopy biopsy
results adenocarcinoma. he was on waiting list for operation the specialist
will remove cancer within is locate in 17 cm above anum and temporary stoma
P/H healthy F/H father had bowel cancer mother had heart problem smoker and social alcohol the examiner kept asking he is on waiting list how to quit smoking? what would happen before operation? (DVT, bowel problems, medications).
13 35 year old male known to your surgery whose father died 3 days ago of a massive myocardial infarction. He is worried about the possibility of the same happening to him. Also concerned about his mother who does not seem to coping very wellnote I explained to him what myocardial infarction is and I went through the cardiovascular risk factor and advised him regarding them I offered a consultation with his mother but she was not keen to come to the surgery so I suggested a home visit at the end of the case the observer examiner asked me about the causes of sudden death
14.A 26 year old women presenting to you after her father sudden death 1 month ago at the age of 57 years which was completely unexpected because he neither complained nor visited a doctor in the last 20 years he was not smoker did not drink alcohol did not have any know risk factor for cardiovascular disease postmortem examination proved massive myocardial infarction her mother is patent of yours for 20 year visited you just before the death of her husband and her medical check up was normal the woman presenting to you today wants to wants to enquire about the reason of her father death and also she is concerned about her mother who is still in shock she thinks that her mothers grief may has exceeded limits because she claims seeing and having her husband feeling of blame
15.45 year old man bleeding after opening his bowel
16.40 year old man has observe bright red blood on his feces he had a back injury some years ago and is taking pain tablets which he buys over the counter
Second stage
1 . 24 years old female present d to your surgery after an eversion injury
to left ankle today she has limited rage of an active and passive movement
especially lateral flexion. There is swelling & tenderness crepitus on
lateral malleolus, other examination are limited because of pain. You have
an urgent x-ray of left ankle AP and lateral
Your task View the x-ray that you have ordered
Explain for the examiner about finding and management plan
Advise the patient (a comminuted fracture of distal fibula. how long it take
to heal how long it takes to move? does she need physiotherapy what is you first management now)
2 a video showing 42 year old lady being interviewed, the lady was saying
that she has erratic eating and binge eating since aged 15 year your task to tell the examiner about her mental status. Answer the examiner and give your provisional & differential diagnosis. The examiner asked me what are the other things you want to know and not present in this video. (Patient rapport?? examiner every thing is guarded I would like to ask about suicidal attempt, hallucination) provisional diagnosis is bulimia nervosa next question what other physical problem you have to exclude
3 A Victorian police officer 31 is your patient for a long time, presented
by her senior officer because of changing behavior, less performance at work having sick leave in beginning of each roaster she also starts drinking alcohol in the last few months. Your task is take further relevant history and give 3 differential diagnosis
answer the examiner question from the history she had two accident one of her colleague died in front of her and another of fire shooting accident.
She didn’t have counseling after that she complains of insomnia, poor
concentration, loss of appetite, drinks 6-8 glasses of wine/ day feels
depressed and lives alone she has history of depression and feels life is
not worthy of living provisional diagnosis PTSD leading to depression and
alcohol abuse examiner asks about short term effects of alcohol and normal limit of alcohol drinking per day and week
4 a young patient presents to you with injury to rt writ your task take
further relevant history, examine the patient, explain diagnosis, exact
injury
5 a 35 year old female presented to you with dysuria, frequency and burning sensation you have ordered dipstick of urine for her, which shows protein urea and nitrate. Your task is explain the diagnosis what is your advice for the patient about management write a prescription
6 35 years old female in general medical ward she has long history of
controlled NIDDM your task is examine the patient tell the examiner about
your findings a sgyo go she has peripheral neuropathy with two rounded red smooth and non ulcerating skin patches you are not allowed to take further history
7 24 years old presented to you with repeated increase in bp it was checked two times in the last few weeks and you check it today is still the same reading which was 150/105 she does not have any complaints, on physical examination she was normal her bp was checked once years ago it was 130/80 when her previous gp commenced her on ocp your task is take further relevant history explain your management plan to the patient
8 a 60 year old female patient complaining of backache. her x-ray showed osteoporosis which was confirmed by low bone densitometery scan take further relevant history examine patient the diagnosis, advise her patient about you management plan, the patient asked about HRT, what are the contraindication, if she should not take the HRT what other tablets she should take
9 a 35 yr old male presented to you with backache after lifting heavy weight at work your task is to examine the patient give your diagnosis the patient has L5 nerve root compression
10 a 45 year old male alcoholic presented to with you, real patent, your
task is to examine the abdomen of this patient, tell the examiner about your finding as you go, patient has hepatomegaly with ascites
11 a 25 year old male a basket ball player presented with anterior shoulder dislocation while he was playing basket ball, the dislocated shoulder was reduce by another gp the patient has history of previous anterior shoulder dislocation before two months, he has history of loss of sensation in other part of the arm your tasks is to perform relevant physical examination, tell the patient about your management and answer the examiner questions, which nerve is affected by anterior dislocation, can be always posterior dislocation do you need any further investigation
What will be the further management for this player?
12 a 18 year old female present to you by her brother, she had RTI 3 days ago, temp 40 she is drowsy and lethargic your are unable to communicate to her o/e no neck stiffness has had a rash (the picture will be shown to you in examination room) your task is give the brother your diagnosis what are your advice regarding further management the examiner asked what would you do to this patient before sending her to hospital antibiotics what type what is the dose.
Brisbanse 29th October
1) My first case was a snake bite . How do you manage it? in the ankle,
pateint stable, young, bitten 30 minutes back
2) A 3 yr kid with previous dx of asthma, hospitalized for a week , he is
going to get discharged, Talk to the father (counselling) Spacer counselling
3) Liver metastaisis, counsel, and tell about the diagnosis and
investigations (repeat from adelaide)
4) A patient with known hemaoohoids 65 yrs, comes with left illaic fossa
pain pain and discomfort, in further talking we realise that his father has
colon cancer, talk to him about his investigation. He was tired, no waight
loss, no colonscopy done before. Might be cancer so rule that out
5) Patient with known 1.5 cm breast mass, FNAC diagnosis cancer, patient
asked what the specialist will do? Cure rate No lymph node clinically
palpable. Discuss about tt
6) young girl with severe headache from yesterday morning, furter
photophobia, neck stiffness, ask for CT scan and admit to hospital with dx
of subacranoid hemorrhage. Slight fever so rule out meningitis also.
7) 30 hour newbornwith jaundice but parents have noticed jaundice before 24 hours as well : ABO incompatiblity, pt is well but yellow manage and counsel father. Mother 0 + and baby A+
8).Girl caring for a end stage cancer mother, all of sudden she lost her voice. Funny station. Ask about HEADSSS, she could only nod yes or no. Asked about
suicide, and finally I get her to answer me by writting, but the time run
out when I had asked just two questions to be written including her name.
9) Examination of diabetic foot. No finding except glove and stocking
sensory neuropathy. No motor, no pulse. basically normal person acting as a diabetic.Vibration was ok.
10) young 40 yr od man , first time UTI manage it, Since it is first in male
below 60 he sould be investigated. He was asking why should I get
investigations. What antibiotics > trimethoprim.
11) Patient has huge pneumothorax, without symptoms, first episode. Young male. Hat to do, when someone else asked about aspiration he was asking are you sure. I just managed conservatively.
12) Recurrent abortion at 8 weeks and 10 weeks andeveryting else including all imaginable investigations were normal. Including blood : anti
phospholipids, USG, chromosomal, hisograms. pt asked about cerclage, but I refused as it is not 2nd trimester abortion. Referred to get rid of the case
13) 5 yr old boy, with fever and leg pain, slightly under the knee. without
any other problem, Possible osteomyleitis, Xray and DD
14) gestational hypertension : 34 weeks now. 150 / 100. Rcollege of obst
says that follow with freq checkings, no drugs , I did that. no proteinuria,
no odema.
15) 55 yr old female with incontinence what to do. Investigations ordered
and asked to do pelvic excercise.
16) Schizophrenic with olanzapine complaining of weight gain, talk ask and investigate., also ask about diabetis.
Queries welcome, will post more details if anyone wants to ask specific
question you are welcome, But remember if you get help from here try to help people later after your exam.....
AMC PART –II CLINICAL EXAMINATION
MELBOURNE 26TH FEB 2005
OSCE
1) You are GP in town, and 38-year-old female presents to your practice c/o
“heart turns”. She has heard that you are very good and wants to talk to
you. She is worried about her heart and describes these as runs of fast
heartbeats, which is pounding and loud enough to be heard. This has been
happening for 6 months every now and then. Your fellow colleague had seen her 2 weeks ago when he did basic blood tests including sugar, Hb,
Electrolytes, Renal and Thyroid Function tests and ECG. All have come
normal. Task: Please take relevant history and tell the diagnosis to the
patient. Answer her questions.
2) You are medical officer in an Emergency Department and a young
19-year-old boy is brought in by the ambulance who was found unconscious in his flat. His flat mate has only recently moved in to his flat and hence has no idea about his past life. In ED, the Airway, Breathing and Circulation has been assessed and secured. Task: Please assess his level of Consciousness (GCS) and other relevant areas to suspect the cause. At the end the examiner would ask you four causes of coma probable in his case.
3) A 24-week pregnant lady comes to your practice who is curious about
circumcision. She wants her son to be circumscribed but has heard both, good and bad about it. Task: Please answer her queries.
4)Your next patient is a 32-year-old lady having 3 kids and wants
sterilization operation on her. She already has discussed this with her
husband and they have agreed to it. Task: Please take relevant history and counsel her regarding sterilization.
5) A 42-year-old patient has come to see you. He is your old patient, had a Bowel Carcinoma 2 years back was operated for the same and was doing well until 3 weeks ago when he developed Ac Intestinal Obstruction and was taken to ED. Laprotomy was performed to see that the cancer has spread beyond pelvis, into the mesentry, liver, para-aortic LNs, peritoneum. Grossly adhered loops and obstructive growth recurrence was cleared with great difficulty, and an end-to-end enterostomy was performed. Now his bowel function is normal. On discharge he was given Panadol 1G q4h for pain, which is not doing enough. He has come for pain in pelvis. Also he is worried and wants to know about his disease and condition. Task: Please tell the patient his condition, and develop a plan for him. Answer any questions he has to
ask.
6)A man comes to you c/o tired ness, week ness and problem with his water works. Task: Please take history from the patient, give your differential diagnosis to the examiner and answer any question he has to ask.
7) Photograph of Alopecia Areata. This gentle man comes to your practice
with c/o hair loss over a period of 4 weeks. Now he is worried about his
condition. Task: Please tell the patient the diagnosis and answer any
question he has to ask.
You are in ED as medical officer, and a father bring his 2-year-old son who was unwell for last 2 days with ear infection, and had a fit today morning at home which lasted for 5 min. When you examine him, he is playing and looks alert and cheerful. The father is worried about his son. Task: Please explain to him what is going on, and answer his questions.
You are night intern and are call by the surgical ward nurse to see a
patient who had undergone a laparotomy 6 hours ago for a perforated peptic ulcer. She is worried that he hasn’t passed any urine since the surgery. He has a temp of 37.8, Pulse of 110, and a BP of 124/82. He has a NGT in place, which has drained 350 mls of bilious fluid from his stomach. He has been receiving Dextrose 5% 1L over 6 HRS, which is about to finish now. Task:
Please examine the patient, find out the cause of anuria, and write down a
management plan including fluid order for this patient. The examiner will
then ask you some questions
9) A 35-year-old lady comes to your surgery and wants to see you to get a letter to the Ministry of Housing to enable her to change her location. Her worry is that her neighbours are playing games with her. Task: Please take proper history and give the differential diagnosis to the examiner.
10) You are medical officer in Obs and Gynae ward and are stitching an
episiotomy of a young woman who has just delivered a healthy 3.5 KG boy by forceps. This was her first pregnancy. Suddenly she has generalized convulsions and becomes unconscious. Task: Please ask for examination finding from the examiner (No history please), and tell the lady’s husband who is sitting outside the labour room, as to what has happened. Answer any questions he has to ask. The examiner will then ask you to manage this patient.
11) A 55-year-old taxi driver comes to your practice c/o very severe pain in his right great toe for last 2 days. He denies and injury. He takes
indepamide for BP, smokes 20 cig / day and drinks about 3-4 beers / day. You find that his great toe is swollen, red and tender. Task: Please tell the
patient the diagnosis and what investigations you would do. Also plan a
management for him.
12) A 36 week pregnant lady comes to your surgery because she is puzzled, if
breast-feeding is better or not than formula feeding. Her friends have told
her that breast-feeding causes anemia in child and also that it causes
breasts to hang down, obesity and weakness. She is very health conscious and educated lady. Task: Please tell her which is the best option and why, and also answer her questions. Also explain to her the steps of safe formula feeding.
13) A young female of 25 years comes to the ED, where you are MO, with
severe pain on the right side of her abdomen. Task: Please take relevant
history ask the examiner for physical finding and to provide differential
diagnosis. You will be asked about management.
14) A 27 years old 30-week pregnant female comes to you with h/o sudden pain
abdomen with some bleeding P/V 2 hrs ago. Now she is settled. Task: Please take relevant history, ask for physical findings, do proper investigations and reach a diagnosis. Examiner will then ask you further questions regarding management.
15) A 65 years man comes to your surgery with c/o gradual onset of pain in shoulders and pelvis over last 6 months. Task: Please take relevant h/o, ask for physical findings, and investigations, and give differentials. You may
be asked about management.
Answers:
Anxiety
REST
Coma (GCS) assessment
Circumcision in New born
Sterilization in 32YO F
Advance Bowel Carcinoma
REST
BPH
Alopecia Areata
Febrile convulsion
Post op Fluid balance
REST
Paranoid Schizophrenia
Post Partum Eclampsia
Gout
Breast Feeding Vs Formula Feeding
REST
Brisbane
1. pyloric stenosis
2. 40 weeks fetal death in utero
3. 28 weeks pregnant with ovarian cyst
4. 4. hyperprolactinemia noral FSH LH 28 years
5. OM serious
6. Tx of RA
7. sexual abuse
8. abdominal plain with jaundice increase ALT UTI in 6 month dd and tx
Adelaide
Carpal tunnel examine the hand
Counsel for appendectomy
GIT exam of chronic liver disease
25 year girl with recurrent UTI
Rugby player with knee injury complaining of knee pain
CNS exam
Woman on the HRT counseling
Male intermittent claudication
Acute cholecytectomy surgical counseling
Male gp cvs murmurs systolic as
Female with DVT management
Hand exam osteoarthritis
pediatric
5 y/o wheezing
Eczema on hand
Soiling
16 year with DM sugar 5 taking thiazide
Sydney stage 2
80 year male going overseas gp found murmur systolic know causes usually as
70 yrMale admitted previously with 2 episodes of hematemisis
Examine GIT liver spleen know borders and technique
peptic ulcer
portal hypertension
White nail
Duputyrens(negative)
Hepatomegaly (positive)
tremor (negative)
jaundice (negative)
What invention FBC LFTS clotting studies
Chronic liver diseases can’t be ruled out might have ruptured esophageal
varices
Female on pill of 3 years diastolic BP 105 mmHg
Kidney problem
polyurea
Known causes of high BP discuss factors long term management stop ocp and
other forms of contraception diagnosis fibromuscular dysplasia because she
still young
Video about a woman talking and about eating problem what is your dd
anorexia & bulimia
Renal colic explain to patient the condition long term management pain
relief very important
Investigations IVU
Patient with RUQ pain his five jaundice (negative) exam in abdomen acute
cholecystitis and then explain why
60 year old woman diabetic for 5 years in hypoglycemia
Discuss risk factor of diabetes
What are the hypoglycemic drugs suited for him advice
Girl in coma brought in ED by flat mate who did not know anything what to do
abc Glasgow coma scale
pupils
FBC
blood culture
bsl
ct scan
parent look stable in observation room what you ddx
drugs dose epilepsy diabetes
Boy at work cut right wrists palmer examine ulnar nerve damage flexor
digitorum profundus superficailis
Breast exam technique
dummy breast on table but still treat it as a person introduce yourself and
explain what you are about to do
FNA lump on neck Bx result SCC where do think the primary lesion anything
around month neck chest
Investigation CT scan MRI Lymphoma Virchows node lf supraclaivular fro GIT
metastasis
PR bleeding for 3 week s 28 yrs father with colon ca d I am considering
colonic a I would like to request t for FBC colonoscopy if old do
sigmoidoscopy then proctoscopy
Stage 2 Melbourne 2002 April
1 36 year old female pre examination PR bleeding please take the history and outline the management positive family history of bowel cancer mother died of it at the age of 46
2 25 year old non smokers complaining of sudden onset of exertional dyspenia please take the relevant history outline the management and prevention (look in CVS and RS examination x-ray explain)
Young girl present to ED complaining of RIF pain of 1 day duration
surgical registrar made the diagnosis is acute appendicitis you are the
intern please take the history relevant examine and do necessary
investigation. counsel the patient regarding the surgical complications
4 27 year old female in OCP of HBP find BP 135 /104(or 150/100) mm hg
checked you on 3 different occasions you did urine ecg and chest x-ray all
normal please manage the patient
5 18 yr old boys mother died of 2 months ago with cardiac rest now he can’t sleep lack of concentration during daytime he is law student please take brief history and counsel patient
6 60 year old lady 2 year ago had leukemia and treated of the last 20 month her blood count checked is normal her last blood count however showed increase she has another relapse your task is to tell the patient about the relapse of symptoms patient was crying the whole time refusing the chemotherapy management
7 4 year old police women was sent by her supervisor to you regarding her recent poor performance eat work he also noticed about her recent alcohol intake please take the history and out line the management
8 20 year old boy had sustained shoulder joint injury 2-3 week ago now he complains of pain please examine the patient give your diagnosis rotator cuff lesion painful abduction 60-120
9 20 year old boy sudden knee join injury 2-3 weeks ago now present of pain of left internal knee joint please examine the patient diagnosis and
management medial collateral and meniscus tear
10 55 year old male presents of lump on the back of the neck lipoma please examine outline the management now to do fine needle aspiration and cytology excision biopsy
11 45 year old male heavy alcoholic present to ED complain of hematemesis please do relevant examination and out line the management
12 50 year old male now present to left leg weakness NIDDM I week ago he had similar episode associate expressive dysphsia please examine the leg (neurology 0 where else would you like to examine the patient what are the investigation give 2-3 main advise to the patient
mcat sept 2001
History give pain tingling R hand especially at right for 3/52 exam and
counsel patient carpal tunnel syndrome (thickening of flexor retinculam
trapped median nerve in the carpal tunnel)
Exam this patients hand give a differential diagnosis how to investigate
and manage osteoarthritis
Pt presents to ED after vomiting 500 ml of fresh blood had previous
history of hematemeis and found to have esophageal varices on endoscope he has history of alcohol abuse exam the appropriately
Pt presented to ED after a fall on occipital region had short duration of
LOC how You have examined her and found marked tenderness at R
hypochondrium. temp 38 pulse 100/min BP 140/90 you have ordered an us exam please look at the us counsel pt appropriately acute hepatitis
Management cases
24 year old man single urethra discharge culture G diplococcus discuss drug course route screen other STD prevention prognosis fowl up
Bowel ca resect rectum now recurrent
25 y/o wants vasectomy
Respiratory COAD, asthma show to resolve pneumonia coin lesion on x-ray
Cardiology palpitation atrial fibrillation angina myocardial infarct his
blood pressure
Neurology TIA completed stoke migraine carpal tunnel SAH
Endocrine diabetic new diagnosis IDDM migraine diabetes random elevated
sugar hyperthyroid
Rheumatology got osteoarthritis rheumatoid arthritis
Gastroentology Diarrhea irritable bowel constipation hepatitis duodenal or
gastric ulcer
Psychiatry depression anxiety bereavement
Renal hematuria
Renal colic
Vascular surgery claudication TIA abdominal aneurysm
GI surgery gall stone colonic ca
Genetics x linked autosomal dominant and recessive
the mcats part of the clinical examination
1.the task is to comment on the mental state and the differential diagnosis
of as woman after watching a recorded videotape of and interview by her
psychiatrist. The sound quality was really bad but the woman looked a bit
disorganized in appearance with slight hysterical feature and the subject of the interview was about bulimia nervosa
2.a woman with diabetes mellitus has come to you for medical cure up
systemic exam is normal complete the check up and your advise to the patient
3.a 23 year old female was found unconscious examine her and asses the
degree of coma Then give the differential diagnosis this was solely a role
play station
4.a 26 year of man has come to you complains of renal colic and the
examiner hand and an IVU showing a filling defect in renal pelvis explain to the patient to you management
5.a 24 year old female present to you because of her blood pressure with
was 140 /104 on 2 occasions measure by a nurse and today is 140/100. Explain your management to the patient.
6.a 54 year old male presenting with acute severe epigastric pain that
faded over the last couple of hours. he had fever 38 and tenderness on the upper abdomen examine the abdomen and give your diagnosis
7.a 46 year old man consulting you before his overseas travel and you
discovered a murmur on his chest he had normal water hammer pulsation and visible neck pulsations and faint diastolic murmur best heard on the aortic area and on leaning downward during expiration examine the CVS
8.examine the GIT system of this man who is 58 years old alcoholic
9.examine this man who sustained and injury to his wrist during his work
with a sharp instrument a role player with band on his wrist than I was
asked not to remove examination revealed a median nerve injury and injury to ulna half of flexor digitorum profundus then I was asked about how to mange such a case
10.a 25 year old male complain of passing blood after passing stool my task was to take a history and to mange the case.
11.10 month old baby girl with recurrent URTI in between episode she has a moist young developed a dry cough that age of 5 months now there is a
medical problem no failure to thrive and passing one broken stool a day the with history of mild asthma she is in day care 3 days a week immunization up to date
step 2 mcats
75 year old male with murmur examine his cardiovascular system
55 year old male with 2 episode of hametemesis advised to stop drinking
examine his GIT
3 42 year old male with renal colic explanation and long term management
4 3 minute duration video of male talking about eating patterns then asked
of and mental state to the patient
5 27 year old male with history of per rectal bleeding
6 breast examination in a model and in a patient
7 male with lump in base of neck who had fine needle aspiration with c
return squamous cell ca examine him and give differential diagnosis
8 27 year old female on the pill for 3 years. in a routine check up she has
been found to have diastolic of 105 mmHg management
9 male with injury to his left wrist deep laceration examine his and tell
what has been damaged it was ulnar nerve flexor tendons
10 55 year old female non insulin dependant for 5 years controlled by diet
and oral hypoglycemics follow up examination of relevant systems
11 male in his 50s with pain in the upper quadrant for 3 days also pyrexia
and vomited once take a brief history at the same time you examine him
explain your differential diagnosis and management
12 21 year old female brought to emergency department by her flat mate found
to be unconscious there is no history no personal details what are you going
to do in the emergency department asked about causes of coma relevant
investigation and also coma scale she had a GCS of 12 over 15 then.
Stage 2
Station 1 70 year old lady with SOB examine her cardiovascular system
comment on your findings as you got through pacemaker present mitral
regurgitation aortic stenosis mild JVP elevated
Station 2 read and proceed
Laminate a4 paper
This 40 year old man attending the ED with vomiting of small amount of fresh blood he had similar episode in the past but treated conservatively now she is hemodynamically stable he also says that he is unable to give up drinking in spite of repeated advice examine this patient
relatively obvious case of chronic liver disease with evidence of portal
hypertension spider neavi gynecomastia distended abdomen with loss of male distribution of hair with abodmen and axilla testicular atrophy left side testes is very small soft and atrophic just like birdseed liver 4 cm below costal margin spleen just palpable ascites pr not allowed no ankle edema no fetor hepaticus no flapping tremor
Station 3 resting station
Station 4 Read and proceed this 26 year old girl thought to have high blood pressure of 150/105 on a routine examination the pressure was checked on repeated occasions and still found to be high she is on pill combined for the last 3 years but BP was normal 3 years ago before her first prescription. The previous doctor could not find any abnormality on physical examination your task is to take a relevant history examine
discuss how are you going to proceed further history did not give any clue
of a secondary cause physical examination and office test did not show organ damage
Hence mentioned about the investigations
FBC
ecg
LFTs
TFT
24 her urine for vma
cxr
us scan
kub
bsi
Station 5
introduction by the psychiatrist
in this station a 3 minute interviews will be played in the video your task
is to do a mental state examination of the patient and come to a reasonable diagnosis with other differentials you will give 2 minute to prepare your self and use this pen and pad of any notes with you ready this video will be displayed
Interview
Female patient but her statements were not very clear but few clues were
thereStill at night time I tend to eat more but I try to bring it out doctor
Sometime I us purgativesI lost 5 kg but not very happy still
For mental state examination follow the below mention rule
Appearance (clothing, hygiene, makeup)
Behavior (posture eyes contact etc)
Conversation (rate tone content flow of ideas)
Affect mood suicidal thoughts
Perception
Cognition
M memory shot and long term memory
O Orientation
A Attention
T Thought process
Judgment how well responding to demands in society the is patient a thereat
to self or to others
Insight about his illness
Rapport
Dd
Bulimia nervosa
Depression
Anorexia
Endocrine thyroid
Station 6
This 25 year old male patient suffered an episode of abdominal pain which
radiated from right loin to groin and was shooting down his scrotum now he is pain free.Task come to a reasonable diagnosis explain and discuss about your management
Discuss Ureteric colic is the most likely diagnosis
Principles of management
Investigation to find out the cause FBC EVC blood calcium phosphate uric
acid us can IVU x-ray KUB.
If it is at one establish the size already existing damage wheter
intervention necessary at this stage
How to tackle the pain if it recurs
Pain relief indocid suppositories other analgesics to take home if
If intervention necessary they meant the methods available briefly IVU
showed dilated calyces of rt kidney.
Station 7
This 40 year old man came with right hypochondrial pain and fever with chill and rigors
Examine the abdominal system discus your management
On examination icteric febrile 38
RBC positive Murphy’s sign
Pr not allowed
Patient also had obvious clubbing
Discussion could it be ascending cholangitis hence nil orally IV cannula
catheter monitor vitals
Pain relief operates
Antibiotics ampicillin gentamicin metoronidazole
Hydration
Blood FBC EVC LFTs culture
Group and save
Obtain consent in case of cholecystectomy
Station 8 resting station
Station 9 read and proceed this 45 year old lady with diabetes of 65 years
comes to your clinic for a routine check up she is on oral hypoglycemia only take relevant history examine appropriately discuss about your plan
History find out any organ damage eye heart kidney nerves
Go through blood sugar diary BSL was between 4.5 and 6.5 on two occasions it was more than 9.4 and other two occasions she had migraine for the whole day went out for lunch and difficulties or doubt about glucose monitoring.Examination of fundi
BP
Lower limbs neuropathy ulcers callous cones
Urine Albumin
Blood BSL
HbA1C
Lipid Profile
EVC
Station 10
This 60 year old man had a lump as showing the picture (picture showed
enlarged supraclavicular lymph node) the FNAC showed moderately
differentiated squamous cell carcinoma.
Task talk to the patent to clarify and possible caused and perform a
relevant examination explain him about your plan
Most likely cause is brochogenic carcinoma or skin cancer ca esophagus very rarely, asked about
hemoptysis cough
Smoking etc examination
Hands
Clubbing
Nicotine stain
T1 lesion
Wrist tenderness pulmonary osteoarthropathy
Face Horner’s syndrome
Lungs pleural effusion etc
Tests cxr bronchoscopy etc
Station 11
Read proceed
This is a 26 year old female lives in a flat but the flat mate does not know
about their occupant as she moved in last week only. This morning she was found on the floor unconscious flat mate called the ambulance and sent to the hospital airway and circulation are stable
Now consider you are the doctor on duty and show the examiner what you would do
Call for help: blue code
Immediate assessment cannula bloods cardiac monitor pulse oximeter finger prick BSL catheter PRN
Shake the patient gently because she is a role player
Say open your eyes for do know where your are
Pinch gently she opened her eyes and closed it again put you legs/ hands up Pupils reactive
GCS was 7-8
Look of indication marks drug addicts
Search of head injury
Neck stiffness Kernig’s signs
then proceed to do CUS RS and CNS
Examiner asked what should be the cause of this state
Toxin poisonous opiates/drugs organophosphorus
Infection septicemia meningitis esp. meningococcal examine specifically
asked
The patient mimicked of having neck stiffness
The antibiotics would be ceftrixone benzyl penicillin
Then depending on the two reports choose one of the two
Blood urine CSF for polymerase chain reaction PCR
Head injury CT
Hypoglycemia
Station 12 read and proceed
This 25 year old man complain of bleeding pr on and off for there weeks
Task take a relevant history
Counsel the patient regarding further examination
History fresh blood after defecation
Bright red in color other features to suggest any management of infective
process. Further analysis father had ca colon at the age of 52 and had some surgery but lived up to the age of 80 years
Two brother healthy
Examination of patent not allowed
This patient needs referral to a gasteroentologist
Colonoscopy flexible sigmoidoscopy
Follow up and screening to be began before the age of 46 year
Include his brother as well of screening program
Screening includes fecal occult blood testing and colonoscopy or Ba enema
Trace his fathers pathology report if possible
Diet advice
Presently the problem may well be due to hemorrhoids which needs appropriate treatment but because of the family history of ca colon he needs a through
investigation.
Station 13 resting station
Station 14 role playing patient with crepe bandage around the right wrist
This is 18 year old boy sustained a cut injury on the ventral aspect of
right wrist. Examine his hand
Look of damage to blood vessels
Radial and ulnar arterial pulses
Capillary refilling time
Damage to nerves motor and sensory function ulnar medial cranial nerves
Skin sensation of pin prick
Patient demonstrates ulna nerve damage ulnar claw impaired pin prick over
little and ring fingers
Examiner observes how to check for never functions and asked about ulnar
paradox
Tendon damage
Other questions asked the small muscle supplied by the median nerve action
of lumbrical muscle
Station 15 a breast prosthesis was kept on the table examiner asked to
examine this breast prosthesis and find out the lump well defined 0.5 cm
lumpFirm in consistency now examine this male patent but consider him as a female the a real of the lump is marked on his right chest show us how you will examine this patient routine breast examination.
2001 oct stage 2 mcats
1 a 75 year old male with murmur or a 46 year old man consulting you before his overseas travel and you discovered a murmur on his chest he had normal water hammer pulsation and visible neck pulsations and a faint diastolic murmur best heard on the aortic area and on leaning forwards during expiration examine his cardiovascular system
2 55 year old male with 2 episode of hematemis advised to stop drinking