15 May 2015

Vomiting and lower abdominal pain in early pregnancy - tasks : Hx (vomiting for a few
days. all ANC normal, waterworks- burning sensation, inc frequency), PE findings (mild
dehydration, urine dipstick +, temp 39), Dx (UTI) and Mx.
50/M c/o headache.
Task- Hx, DDx and reasons.
Hx: where? Band like distribution around head (pt points it out). 3-4/10 intensity. Dull
aching pain. No particular time of day in onset, but tends to get worse at night. No other
associated Sx (no lacrimation, rhinorrhea, photophobia ...etc). Under some stress, but
family is happy.
Dx:most likely your condition is tension headache d/t stress.
DDx: but we can do some other Ix to rule out other possible causes such as migraine,
cluster, SOL...etc.
SCC re excision counseling
Pt had lesion excised from temple last week. Was told lesion probably benign. Histology
reports came back as SCC. Pt has come in today to take stitches out.
Task- explain results of histo reports to pt. tell him what the next steps are (Mx).
IMN - PE.
Pt had sore throat a couple days ago, blood tests show lymphocytosis. Monospot + .
Task: do PE. Explain findings to pt not examiner. no further Hx needed. Explain Dx and
Mx.
Lower limb compound fracture - PE
Pt involved in MVA. Primary survey cleared. Photo of legs and X-ray of fractures given.
(Photo shows oedema, erythema with wound. No active bleeding or bones protruding. -compartment syndrome) X-ray shows compound fracture of tib and fib.
Task- explain X-ray to pt. do PE. Running commentary. Explain immediate Mx to pt.
42 y/o woman with Hx of Headache on and off the the last year with photophobia
(migraine Sx). Not related to food. Last episode was last month. Went to ED couple of
days ago got ct done. Contrast ct scan reported as normal. Mum had migraine that was
difficult to treat. No stress at home. But headache is interfering with life.
Task- focussed Hx no more than 2 min. explain ct results to pt, possible Dx and Mx.
Child abuse. 3 month baby. Mum and dad both uni students. Mum says dad told her baby
rolled off changing table. Bruises on cheeks.
Task- Hx, Mx.
Hx: mum brings baby in with bruising on cheeks. When asked about stress/how's she
coping, pt begins crying - offer tissue (kaching!). First baby, unplanned but she loves

him.
Mx: organize blood tests etc... But need to call child protection agency (pt gets defensive
now), tell her she is doing a great job, but the CPA will try to assess the safety of baby let her know all our best interest is for the baby. She agrees with you.
breech in 36 week GA
Task- take any further Hx you need, explain to pt her condition, Mx.
Hx: first baby, planned pregnancy. Wishes to have NVD. When warned about possible
dangers for baby if delivering via breech, pt is ok for CS. Pt has good support from
husband, and her mum will be helping her at home when she delivers.
Mx: as per breech Mx in book.
45/F, heavy period for last 18 months.
Tasks: Hx, PE findings from examiner, Mx. Regular periods, was 6 days, now lasts 9
days with clots. Soaks 6 pads per day. Haven't noticed other Sx. Fhx insignificant. PE:
slightly pale, VS normal, systemic exam normal. Pelvic exam - inspection normal,
speculum healthy vagina and cervix. Bi manual - uterus enlarged to 10 weeks. Tell pt
about Ix and Mx.
Psych- 34 /M, unemployed, presents with cut on extensor surface of forearm. Bandaged
up. Nurse told him to see you as she's worried about suicide.
Task: take Hx focussing on suicide risk. Report MSE to examiner esp comment on
mood, insight and judgment.
Hx: Cutting to relieve stress - has done it heaps of times before when he was young. This
time he was supposed to meet some friends who didn't show up, so he got upset and cut
himself. Doesn't do it to kill himself. Took a bunch of Valium when younger once, didn't
think he was trying to kill himself- trying to get attention. Was treated in ED. Had been in
counseling for a year but therapist moved away, now he's finding it hard to find another
therapist he trusts.
MSE: appropriately dressed, speech tone/speed/contents all normal (pt talks sense and
answers whatever you ask him). Mood is not low at the moment. No perception
disturbances. Thought form and content normal. Insight good- knows he needs/wants
therapy. Judgement intact.
Alcoholic counseling.
Middle Aged man used to drink a lot. Quit 3 years back when wife urged him to seek help
coz of ED but he started drinking again 6 months ago at a friend's wedding. Blood
tests given: GGT:75, TG increased, MCV 110 fl. All other tests normal.
Tasks: explain blood test results to pt, ask him about his drinking problem (cage), assess
his desire to quit, counsel him about quitting.
40's/M c/o Indigestion. He appears sweaty. ED.
Tasks: take Hx , ask examiner for PE findings - given to you on a piece of paper.

**present the case as if you're presenting it to your registrar** , order Ix for your DDx examiner may give you result for one of them. Immediate Mx.
Hx: indigestion, started an hour (?) ago. had indigestion before but his time feels diff. In
pain 5/10. traveling up to jaw. Hx of MI 3 years ago. Not related to food. No associated
Sx.
PE findings - pt a bit distressed, sweaty, VS somewhat stable I think.
DDx"We have Mr. John Smith, a 43 year old accountant, complaining of indigestion for the
last hour. Mr. Smith appears anxious and sweaty and is in moderate amount of pain...
etc....
There could be a few causes for his condition that we need to rule out including aortic
dissection, ruptured oesophagus/PUD - erect X-ray, CT and
MI - ECG --> examiner hands you the ECG. Now interpret and present the ECG findings
to examiner.
Immediate Mx: MONA.
18month old baby. Brought in by dad. Difficulty breathing and swallowing noticed
overnight.
Tasks: Hx, PE findings from examiner, tell the dad Possible causes of baby's condition, Ix
and Mx.
Hx: baby was doing well until yesterday, when parents noticed he couldn't breath or
swallow. Dad noticed baby's a bit feverish.
PE: T= 39, tachycardic, BP normal.
Explain: could be foreign body- do X-ray. Could be epiglottitis- indirect laryngoscopy.
Croup--> give Mx.
9 year old c/o pain in right leg - doesn't want to put weight on it. Limps. Started a few
months ago on and off. Yesterday pain started after playing sports.
Tasks- short Hx & PE findings from examiner (no more than 5 min?), explain X-ray to
dad. Tell him the Dx and Mx.
PE- pain on abduction & internal rotation of right leg. All other ROM ok. Growth chart
97th centile for weight. 50th centile for height.
X-ray of hip shows SCFE of right leg.
Explain SCFE to dad and Mx.
Tiredness for the past year.
Task- take Hx, Give DDx and Ix and reasons.
Nothing significant in Hx. No anemia, no blood in poo, no weather pref, no infections, no
renal ds, no DM, no sleep problems (I forgot what the rest of mnemonics were).. So I
started asking depression Q to fill in time. Nothing there. SADMA negative.
Telling DDx- told pt we will run blood works- fbe to look for anemia, TFT for thyroid ds,
esr/crp for infections, EUC, RFT for renal functions, BSL for DM, FOBT for CRC ...

Pt noticed bleeding when opening bowels.

tasks- Hx, PE findings will be given on a paper, DDx, Ix and reasons for each to pt.
Hx: Fresh blood. Past year. Occasional constipation. Mainly meat diet. Doesn't like
veges. On surface not mixed in. Father had CRC at 55, he is now 70. No LOA/LOW, no
LAD.
PE findings given on a sheet: all parameters normal. DRE nothing felt- no blood on
finger
DDx- haemorrhoids, diverticulosis, polyps, CRC. Do FObT, colonoscopy - excise polyps
if found - send for histo pathology. Blood works to check anemia.