AMC Clinical Exam Brisbane 24 February 2007

8/13/2019 AMC Clinical Exam Brisbane 24 February 2007

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AMC Clinical Exam Brisbane 24 February 2007

1. A businessman who heard about harmful effects of excess alcohol use and want to

consult with you. (Counseling) :It was my second station and the first station was a rest station. There was a

young gentleman who was the role player. After introducing myself to examiner

and role player I ased him how I could help him. !e told me he is a businessman

and the other day heard about problem drining and now is concerned about his

drining and wants some more information.

I started to as how much has he been drining. "or example what you usually

drin and how many drins a day and when he was not sure about daily drins I

ased about weely drins. !e told me he drins about #$ drins a wee. Then I

started to as about CA%& 'uestions and if he drins during the day or if he feels

if he need any drin to settle. y asing the specific CA%& 'uestions I let the

examiner now I am aware of the approach to the problem.

Then I taled about health problems and social conse'uences of drining too

much and then I explained about safe drining le*els and what is a standard drin.

!e ased if Alcohol already caused any damage to his body and I said we will

now after some in*estigations.

&xaminer ased me what in*estigations+

I said some blood tests lie "& ,"T and li*er -/ at first.

Then I explained about a couple of points about benefits of safe drining (because

I had extra time other wise I already mentioned them briefly) and ased the role

player if he has any more 'uestions or concerns.

!e was happy and no more 'uestions. I ga*e him some written information and

arrange for a follow up appointment in few days and also offered him to 0oin

some support groups if he thins it is difficult for him to reduce the le*el of

drining.

Then I ased the examiner if he has any further 'uestions and he said no.

I left the room before ring.

I passed this station.

1


2/10

. 2ash and allergic reaction on hands of a construction worer. (3x and 4x)

There was a picture and hands with rash and crusts and swollen on the door.

There was a young role player in the room who said he has this rash for few

months. And it is only on his hands (both of them). !e said they are itchy.

I ased what his 0ob was and he said construction worer. I ased if he changed

his 0ob recently and he said yes. I ased if the rash started after his change and he

said yes.

I ased about any pre*ious treatment and allergies and tried to exclude and other

exposure.

Then I taled about wor safety stuff lie glo*es and goggles. And he said he

does not use them.

Then I told him it is an allergic reaction and needs treatment. I explained for him

the best treatment is a*oidance and ad*ise him to change his 0ob. &xaminer said

he can not change his 0ob. Then I said then you should discuss with your boss to

do another duty which minimi5e the exposure and need to wear safety wears lie

glo*es.

As treatment I ga*e him oral antihistaminics and steroid cream (the picture was

*ery se*ere reaction) and I warned him about /& of medications.

I also told him to come bac for follow up as he may need some antibiotics if the

wounds get infected.

I ga*e him some written info about allergy and ased if he has any other concerns.

!e was happy and examiner did not ha*e any 'uestion.

This station was also a short one.


#. A child with meningococcal infection. 4other is worried. &xplain diagnosis and

management.(4x)

"rom the beginning you could say it was meningococcal meningitis from the

history on the door.

I the scenario it was said there were other young children at home.


3/10

I introduce myself to examiner and the role player. I told her her son has

4eningococcal meningitis and ased her if she nows what it is. /he said yes she

heard about that. I explained the disease briefly and told her we will hospitali5e

her son and gi*e I6 fluid and antibiotics and he may need to stay in hospital for

few days. /he ased me if I will transfer him to a larger hospital (7n scenario it

said you are in a country hospital). I said not at this stage because we ha*e

pediatrician at this hospital who can manage this disease. ut she ased again.

This usually means I am on a wrong tract and I need to send the son to a larger

hospital but because I already insisted on eeping him in our hospital and told her

we ha*e pediatrician I could not step bac. /o I reassure her we ha*e good

pediatricians here and they can tae care of her son and if we need to I will

transfer her son to a larger hospital by air ambulance A/A8.

Then she ased me her son had immuni5ation so why he is sic. I explained about

different strains and limitation s of the *accine that we ha*e. Then I ased about

child care and any other persons at home and she said yes he goes to child care.

Then I explained about prophylaxis for young children at home and child care

staff and children and about notifying the authorities.

/he ased if her son will sur*i*e and I reassured her.

I ased about any concerns. 9either she nor the examiner ased any further

'uestions.


. ;ellow


4/10

I ased for examination findings and examiner told me she had greenish

discharge. I got confused because on scenario it said yellow< brown and the

examiner said green. I was thining of bacterial *aginitis or atrophic *agina or =

I could not mae up my mind and I lost the tract. I am not sure how I managed her

but I was not happy with the station myself.

It was the only station I failed.

>. 2heumatoid hand examination. 2eal patient. (examination)

I was a real elderly patient in the room with almost all signs of 2A on his hands.

?hen I entered the room he already put his hands on a pillow and I started to

explained was I saw one by one following hand examination pathway on Talley

@ 7Connor 363. I finished early and had a chat with the examiner. oth

examiner and patients were friendly.


B. immuni5ation schedule and side effects (Counseling)

It was a *ery easy and strait forward station. I ased the role player who was a

young lady what she wants to now about the immuni5ation and she said all

*accination from birth to school age. I started to explain the current schedule. I

new the schedule by heart but if you want you could get a copy of it from the

examiner. After I finished with the immuni5ation schedule she ased about any

side effect and I explained about possible minor side effects lie minor fe*er or

tenderness on the site of in0ection. Also I explained about rare /& lie

anaphylactic shoc. Then I explained contraindications (it was not the tas but

because I new them and I had time I explained them to manage the time.)

I also told her the new *accines ha*e less /& and I explained about ?hooping

cough *accine (old and new ones). Then she ased what if the baby is not

immuni5ed. And I explained about the difference. The examiner was *ery happy

with my explanations and thaned me and wished me good luc. I finished this

station early.



5/10

. 1$ pregnant in labor in a country hospital. 4econium satin but e*ery thing

else normal. 4anage the patient. (4x)

There were ladies one examiner and one role player. The role player was a post

term pregnant woman in labor in a country hospital. /he had #.> cm dilation at

admission and now (after #$ minutes it was cm). I ased about past history and

any medications and allergies. I ased about antenatal care and any abnormalities.

I ased about any obstetrician follow up. I ased about her -/. I ased about any

abnormality discharge= (?hate*er you can thin of) and all was normal.

Then I ased the examiner about the examination findings and she said what

specifically I want. ?hate*er I ased was normal except she had meconium

staining. I ased if the membrane is ruptured and she said yes right now. I ased

about cord prolapsus and she said no. I ased for CT% findings was normal -/

findings was normal "!2 was 1>min. I ased about cephalo


6/10

want. I started to as 'uestions to exclude depression (pseudodementia). Then I

ased the same 'uestions of the 44/& in a different format. I new it was not

the answer but I had to say something and I could not sit there mute. Then

examiner ased me which part of the brain is affected. And I said fronto


7/10

1$. Inade'uate asthma management in a young child. "ocused brief history and write

action plan. (4x)

It was case of a child who uses his relie*er se*eral times a day and still has few

&3 admissions. I started to as mother about the history and the trigger factors

but suddenly the examiner interrupted me and said it is not your tas. 3o your

tas.

At this moment I was so disrupted that it too a few seconds until I could say any

thing. Then I stated to explain for her that her child does not get ade'uate

medication and that is why he has these problems. I told her I would gi*e her an

asthma action plan and add another puffer which is a pre*entor to her childs

medications. At this stage she pulled out a printed action plan with some blan

parts and ga*e it to me.

I started to fill in the blans as I explained for her what a pre*entor is and how it

wors and how her son should tae it. Then I ased if she needs me to show her

how to use the puffer but she said she nows.

&xaminer ased me if I need to ased any other 'uestions and I said no. the

examiner ased me why did not you ased about trigger factors and I said I was

going to but you stopped me. !e did not say any thing and bell rang.

I passed this station also.

11. "emale who had her first deli*ery as C/ and now wants her nd deli*ery as

*aginal. Answer her 'uestions. (Counseling)

I introduced myself to examiner and the role player as usual. /he ased me she

was pregnant and it was her second pregnancy. /he was planing to ha*e her

second deli*ery as *aginal deli*ery. !owe*er she had her first as C/.

I was not sure about the answer. ut I started to use common sense. I told her as

the uterus is a muscular body and will under go a huge tension and pressure

during labor there is a possibility of a rupture in the uterine wall as the scar tissue

which is there after C/ is not as flexible as the rest of muscular uterus. Then I

said that I am not 1$$ sure how big the ris is and I will refer her to an

obstetrician for a second opinion and antenatal care.

/he was happy and then examiner ased me what happens if the uterus ruptures+


8/10

I said it will bleed and it can be life threatening for both mother and baby.

&xaminer was also happy about this.


1. "emale had cholecystectomy B1 ago. 9ow has 2-J pain for few wees and

fe*er. 3iagnose and manage. (3x and 4x)

After introduction I ased her more about the history. I ased when she had

cholecystectomy did they remo*e any part of biliary duct or only the bladder and

she said only gall bladder. I also ased about any complications after operation

and there was none.

Then I ased the examiner about the examination findings.

!e said she is 0aundiced and tender in 2-J. /he was febrile and generally

unwell. Then the examiner ased me about my diagnosis. I said it can be a new

stone formation in biliary system that causes 0aundice. Also it can be subphrenic

hematoma or also it can be right lower lobe atelectasis as a post op complication

(later when I thin about it I understand it was wrong because it was B1 post op

but in the room I did not thin about it). Then I said because she is febrile a strong

possibility is an infection lie cholangitis.

Then examiner ased me what else can it be+ I did not ha*e any more ddx. that

includes fe*er and 0aundice. I had to say something and the most reasonable ddx

in a middle aged or old lady with 0aundice that I could thin about at that time

was neoplasm of head of pancreas. I said this and examiner wa*e his head in

supporting my opinion. Then he ased about management and I said to diagnose

first I do an abdominal -/ and then if necessary CT abdomen. I also do some

blood tests lie "& -@& and ,"T. efore I go any further into management the

bell rang and I had to lea*e.


1#. !ad pel*ic operation (drainage of sigmoid abscess) B> ago. 9ow has pleuritic

chest pain. !as K


9/10

The CK2 showed a consolidation on right side (can be the left I am not sure) and

a small amount of pleural effusion. I started to explain for patient about the K2

finding. And I concluded it is pneumonia and the reason can be an aspiration

during operation. And I will send her to hospital for further assessment and

probably I6 antibiotics. The examiner ased me can aspiration pneumonia occur

B> after operation. I understand it is not the answer they expect but I had to

manage the situation. /o I said it is not *ery liely and there are other ddx. lie 8&

that can happen after pel*ic operations. Then examiner smiled and said go on.

Then I turned to patient and continued. I said as I told you before I am going to

send you to hospital for further assessment which also may include a d


10/10

I started to explain what 4I means and how atherosclerosis forms and how it

causes heart attac. I left enough time to her to digest the information and ased if

she had any 'uestions.

/he ased about her possibility of ha*ing a heart attac. I explained for her that

she has a family history and it is a ris factor. I also told her about oter ris factors

lie being male old age smoing obesity high cholesterol !T 34=

I told her we cant change some ris factors lie age or family history but we can

modify the rest. I taled about weight lose (she was obese) and exercise and

smoing and chec up for !T and cholesterol and 34. I ga*e her some ad*ise

about health diet and ga*e her some written info. I ased her to see me again soon

to discuss her impro*ement.


1B. B$ year. 8!x of renal colic. 3iagnose and

manage. (3x and 4x)

There was an elderly role player in the room. I introduced myself and ased about

his complaint. !e said he has hematuria but no pain (or not much pain I do not

remember but the answer pushed me away from renal colic). !e said he has

fre'uency and when I ased more he said he has dripllng and he feel he can

empty his bladder. I ased about other symptoms of 77 (ladder 7utlet

7bstruction). There were mostly positi*e. Then I ased about examination

findings. I had to as what I was looing for. !e had minimal abdominal

tenderness and palpable bladder and on 82 exam there was enlarged prostate with

smooth regular surface.

I told the patient that I thin he has a 77 and I explained for him what it was

and what are the possible reasons. I told him howe*er I dont thin he has a Ca

prostate (I should not ha*e said this) but I would lie to do some tests lie 4/-

8/A (and I then turn to examiner and said I collected blood before 82 exam) and

pel*ic -/ and refer him to urologist for further tests which may include a

cystoscopy for hematuria and biopsy of prostate. I ga*e him some written info

about 77 and told him to go to &3 in case of acute retention.

&*ery body was happy. I passed this station.

1$

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AMC Clinical Exam Brisbane 24 February 2007