12 May Retest, 2012 Melbourne

Station 3 Rest Station 4 Postoperative fever (same as Book case) Staion 5 26 yo primigravida, 30 wks pregnant, neg(-) blood group, having painless p/v bleeding for 2 hrs. O/E-pt was haemodynamically stable, FHS was normal and mild lower abdominal tenderness on palpation. Task History for 2 min, tell the probable diagnosis, order investigation, tell the management -

Pts ques was- do I need to do anything when Ill get back to home?

History was as usual for APH, on 18 wk USG - placenta was in top of uterus Pretty straightforward case of APH but pt was very anxious so reassured a lot.

AMC Feedback Mild Abruptio Placenta(Failed, dont know why)

Station 6 40 yo chef, came with recent increase in urinary frequency, loss of wt and feeling more thirsty. She didnt have any F/H/O DM. Her body wt was 100 kg and BMI was 39. Task- ask for inv to examiner, tell the dx and Mx to the pt. Inv- FBS was 9, RBS was 16.8; urinary dipstick was ++++ for glucose but neg for bacteria; all other inv were pending Dx was DM2 and managed accordingly Pts ques- can my children get it?

AMC Feedback- Type 2 DM

Station 7 Young male, single parent, who had injury over forehead and had a stitch over it 6 wks ago; now came with boy who had an ankle sprain. you already took care of it. Now u r gonna talk with father who drinks a lot. Task- talk with father On history, he was a courier driver, drinks 36 can beer on wkend but doesnt drink on wk days. never had an accident or RBT + , doesnt have much time to look after his son, so Grandmother look after his son , son has got this ankle sprain during playing and this was first time. Talked about binge drinking, its effect on his life,driving and his boy. Notified to RTA(pt resisted a lot) and Child protection unit, offered help and support group

AMC Feedback Alcohol abuse,Binge drinking (failed)

Station 8 Rest Station 9 40 Yo female came with GIT symptoms. Task - History, Ex, probable Dx and which inv would you do to confirm the dx
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On History- pt had diarrhoea on &off for almost 3 yrs, recently mixed with blood and mucous,has crampy tummy pain, wt loss + ve, Family history () for bowel cancer, nobody on special diet, no travel history, feels a bit hot, not on any medication. Ex-everything normal except mild tenderness on LIF and on D/R/E- anal scar (+) and blood on gloved finger Dx- IBD, Bowel cancer or infection Inv- routine inv + colonoscopy+ stool m/c/s

Station 10

60 yo male has long h/o heart burn, recently had back pain,went to GP, GP prescribed Diclofenac. Now in ED, severe Upper abdominal pain, vomited 2 times.pt is haemodynamically stable Task- Do relevant Ex, ask for inv, manage the patient O/E- pt didnt let to palpate over abdomen due to pain, bowel sound absent, hernia orifice and DRE was normal Inv- abdomen xray was normal, ECG was normal, CXR showed gas under right diaphragm(perforated peptic ulcer) Mx- managed as a case of acute abdomen AMC Feedback- Perforated peptic ulcer

Station 1 ED setting- 60 yo male has severe chest pain, SOB for 2 hrs. O/E pt was haemodynamically stable Task- history, manage Common case of MI with cardiac arrest Offered MONA first , then took history but suddenly pt collapsed so checked DRABC and call for help. Started CPR(2 min) followed by DC Shock(200J), during that ECG showed VT, after 3 DC pt regained consciousness and ECG was acute anterior MI with lateral ischemia, then managed as MI case Examiner kept asking what else!! AMC Feedback - Cardiac arrest in a setting of MI

Station 2 Gp setting- a 9 month old child is not gaining wt properly, nurse is concerned so referred to you. He is now 9 month old,wt is 7.5 kg. Task- plot growth chart, take history, ask Ex, do management
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Growth percentile was 3rd On History- mother was not concerned at all, she thought it is normal as her all family members were skinny! No

family/financial concern, happy family. Baby breast fed till 4 month then started to wean. Wee is ok but poo is little bit loose all the time,3-4 times/day, cant remember since when. BINDS was ok. O/E- everything normal except mild abdominal protrusion. Management- ordered first line inv for FTT(according to RCH), told the probable dx-infection, underlying organic cause, celiac disese etc. Offered an appointment with Paediatrician AMC Feedback - Infant with poor weight gain

Good luck everybody!