Recall 2013 AprilAMC CLINICAL

8/12/2019 Recall 2013 AprilAMC CLINICAL

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6 th April 2013 Melbourne Afternoon Group (Blue)

O & G1. A 68 YO female ame to !our G" lini omplainin# of ra$h %ith $e ere it hine$$ 'o%n belo%for the pa$t 2 !ear$. You %ill be $ho%n a photo b! the e aminer.

a$*$+ a*e hi$tor!,-e$ ribe the ra$h of the photo to !our e aminer. pro ee' a or'in#l!.

i$tor!//// he ha$ been $ufferin# thi$ on'ition for 2 !ear$. he ha$ trie' Oe$tro#en ream butit 'i' not help. o feature of hi$tor!, no menopau$al feature$, no '!$pareunia. "ap $mear re entl!'one an' it %a$ normal. he ha$ 3 *i'$.

"h!$i al am... al! le$ion$ on labia ma ora..., no $in#$ of infe tion, atrophi feature$(4)Other $!$tem e amination$ are normal.

planation....5t i$ a *in' of 'ermatiti$ uite ommon in !our a#e. 5t i$ *no%n a$ li hen $ lero$i$.5 %ill #i e !ou h!'ro orti$one ream %hi h %ill be er! helpful, an' for the it hine$$, 5 an #i e!ou antihi$tamine. But %e 'o ha e er! important i$$ue to be a''re$$e'. hat i$ !ou nee' to bere ie%e' b! a #!nae olo#i$t, to ta*e a $mall pie e of t7$ from it to rule out an er be au$e $ometimeit oul' be a pre ur$or le$ion of a 9ul a. 5 'o not mean that !ou %ill ha e an er but %e u$t ma*e$ure that it i$ not an er. : u happ! %ith thi$;


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re#i$trar.hen e aminer a$*e' me if blee'in# i$ not ontrolle' e en after pla enta 'eli er!, %hat 5 %ill 'o.

5 $ai' that 5 %ill fin' out the au$e of blee'in# e# tear in a#ina, in$pe tion of pla enta forompletene$$ to rule out :"O . hen he tol' me !ou 'on>t fin' an! rea$on, %hat 5 %ill 'o. 5 $ai'

%e mi#ht probabl! thin* of the other rea$on li*e -5 an' 5 a$* him a#ain the blee'in# i$ lotte' ornot.

hen 5 $ai' %e mi#ht thin* of 'oin# laparotom!, then 'oin# uterine arter! or internal ilia arter!li#ation or h!$tere tom! if in'i ate'. hen the ob$er er a$*e' me %hat 5 %ill 'o if pt ha$ -5 . 5$ai' 5 %ill #i e her fre$h bloo' or @@". he bell run#.( 5 mi$$e' to pa$$ urethral atheter )Feedback: Primary Postpartum Haemorrhage (Passed)

3.2 !ear/ol' primi#ra i'a ome$ to !ou to 'i$ u$$ about her 'eli er! at 20 %ee*$ of pre#nan !. erfrien' ha$ 'eli ere' a bab! b! . he al$o hear' that ha in# pre$er e her pel i mu$ le$,an' her a#inal %all %ea*ne$$.Your a$*$..

a*e the hi$tor!.( All in e$ti#ation ha$ been 'one an' all normal) for 3 minute$ ( "h!$i ale amination i$ not nee'e' to be 'one)

oun$el about 9$ normal 'eli er!.

i$tor!... "rimi#ra i'a , planne' pre#nan !, too* O " before, "A" $mear re entl! 'one an'normal. o ompli ation$ $o far 'urin# pre#nan !, feel bab! mo ement normall!, Bloo' #roup O4,

o blee'in# '7o, no pre iou$ $ur#er!, o 'ru# aller#!

oun$ellin#... Ce 'on>t normall! re ommen' %ithout 'efinite in'i ation$ a$ it ha$ ma! ri$*.5t i$ an operation 'urin# %hi h a $mall in i$ion i$ ma'e on !our tumm! %all an' ut the uteru$ tota*e out the bab!. 5t i$ 'one un'er anae$the$ia an' $he %ont *no% or feel it. But there are $ome ri$*$e#, ri$* of GA7 A li*e lo% B" an' $ho *, aller#i rea tion, blee'in#, in ur! to near b! or#an intumm!, infe tion, lon#er ho$pital $ta!, in rea$e ri$* of " , bab! ha$ a ri$* of tran$ient apnoea atta *a$ $e retion$ form the lun#$ not $ ueeDe' out. he benefit i$ an pre$er e pel i mu$ le $ ue$tion.plain about !our mana#ement plan for him.

planation... o $pe ial hi$tor!, no fe er, no omittin#, hil' i$ %ell. 5 e plaine' that !our $onha$ a on'ition alle' -iabete$ an' a$*e' him ho% mu h he *ne% about -M. e $ai' no. hen 5tol' him that in our bo'!, pan rea$ $e ret a hormone alle' in$ulin to *eep bloo' $u#ar le el normal


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hen 5 %a$ bout to tal* a$thma tri##er$ , then the bell run#..Feedback:%&plai!' demo!strate a!d check use of ro!chodilator *I a!d spacer (Paediatric)

6.Boo* a$e on'ition F6 A" G i$tor!.. the hil' ha$ #ot $*in ra$h on hi$ hee* 2 %ee*$ a#o, it impro e b! it$elf %ithout an!

me'i ation$.Feedback: Haematuria i! a child(Passed)

Me'i ine an' ur#er!

F.Boo* a$e on'ition 33... Beni#n $$ential remor %ith hea ! al ohol 'rin*in#Feedback: +remor (Passed)

8.Boo* a$e on'ition ... A$$e$$ment of a omato$e patient"o$iti e fin'in#$ < G 8 to , ne * $tiffne$$, in rea$e tone an' *nee refle on ri#ht lo%er limb.

Feedback: oma (Passed)

.68 !ear/ol' la'! fell on her ri#ht out$tret he' han' an' #ot the pain an' $%ellin# on her ri#ht%ri$t. he i$ite' !ou in - an' H ra!$ ha$ been 'one. ( H ra!$ pi ture %a$ #i en)

a$* (a) plain the fin'in# of H ra!$ to the patient.(b) -i$ u$$ !our follo% up an' mana#ement plan %ith patient.

@ra ture on the 'i$tal en' of ri#ht ra'iu$ an' an#ulation %ith po$terior 'i$pla ement an'impa tion an' thi$ i$ al$o alle' olle>$ fra ture. aminer a$*e' me %hat el$e 5 $ee in the H ra!$. 5'i' not $ee an!thin# el$e an' arpal bone$ are inta t. o 5 $ai' 5 'ont $ee an!thin# el$e an' 5 oul'not $ee arpal bone$ learl!. 5t i$ probabl! 'ue to poor ualit! of photo. (After e am 5 ima#ine ifthere mi#ht be o$teoproti feature in that)

hen 5 tol' her that 5 am #oin# to 'i$ u$$ %ith orthopae'i re#i$trar. e mi#ht ome an' a$$e$$!ou then %ill 'o re'u tion un'er anae$the$ia ( hort GA) an' put the pla$ter on. aminer a$*e'ho% far "O" #oe$.5 $ai' from meta arpophal#eal oint to belo% elbo% in $emi prone po$ition an'arm $lin#.

hen 5 $ai' %e %ill 'o re he * H ra!$ an' $he ha e to be follo%e' up b! a G" or me in 2 hr$. Butif $he e perien e pain, olour han#e$, numbne$$..... , ome ba * here. Ce nee' to remo e the

pla$ter... hen 5 mention ph!$iotherap!..... an' $he %ill $ta! %ith that for to 6 %ee*$ 'epen'in# onher on'ition. 5f it i$ not heale' until that time, $he mi#ht be $ta!in# %ith that up to 8 %ee*$ or

lon#er. 5 al$o mention about o$teopro$i$( hinnin# of the bone$) an' a$* her %hen $he #ot to menopau$ean' if $he #ot : . he $ai' no. hen 5 $ai' there mi#ht be o$tepro$i$ an' $he mi#ht #et - HA$ an 'one. 5f $he ha$ O$teopro$i$, $he ma! #et bi$pho$phonate an' en oura#e her to eat more

al ium, 9it -, 'o more e er i$e, $un e po$ure....Feedback: olles fracture of the $rist(Passed)

10.You are MO in - of a rural ho$pital. A =0 !ear ol' la'! %ho i$ on 'ial!$i$ ame an' i$ite'!ou for the omplaint of palpitation. eart rate i$ F=. he pi ture of G ha$ been $ho%n(9entri ular a h! ar'ia). ( on# $tem)Your a$*$,

(1)-e$ ribe G fin'in# to e aminer.(2) a*e fo u$e' hi$tor! not more than 3 min$.(3)A$* in e$ti#ation from e aminer.


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( ) plain !our mana#ement plan to the patient. aminer i$ "rof Iohn Muta#h. 5 a$*e' him if m! patient %a$ thermo'!nami all! $table or not.

e $ai' her ital$ %ere #i en in the $tem. (A tuall! onl! : %a$ mentione' %hi h i$ F=) an' a$*e'me to pro ee'...

5 $ai' %i'e omple J: omple %ith re#ular heart beat. 5t i$ 9entri ular ta h! ar'ia.

i$tor!... #ettin# 'ial!$i$ on e 3 'a!$. er 'ue i$ tomorro%. he i$ not feelin# %ell an' palpitate'$in e !e$ter'a!. o faintin#, no 'iDDine$$, no he$t pain,...., no fe er.... Gettin# 'ial!$i$ o er 3!ear$.... ta*in# me'$... (a li$t of me'i ation$ %a$ $ho%n b! the patient) Chen 5 a$*e' @B ( normo !ti normo hromi anaemia), B normal , ?& ( E4 F.2, lo% a,hi#h reatine an' urea ) M# an' a not 'one !et...

hen 5 tol' the patient that her pota$$ium le el i$ er! ni#ht no% an' it i$ affe tin# her heart. oher heart i$ beatin# abnormall! an' it i$ *no%n a$ 9 . 5t i$ a $eriou$ on'ition an' it an lea' to a

ri$i$. o !ou %ill be un'er our ob$er ation an' put on ar'ia mornitor. o prote t !our heart, %e%ill #i e !ou 59 al ium #lu oronate. o lo%er E4 le el, %e %ill #i e !ou 5n$ulin an' #lu o$e, eb9entolin an' re$in to 'e rea$e E4 ab$orption from !our bo%el.

he mo$t important thin# %e nee' to 'o i$ ur#ent 'ial!$i$. Ce %ill refer !ou to neare$t ho$pital%hi h ha$ 'ial!$i$ fa ilitie$. he a$*e' me if $he an #o an' 'ri e there. 5 $ai' no an' %e %illarran#e ambulan e ur#entl! to tran$fer her to 'o 'ial!$i$.


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Recall 2013 AprilAMC CLINICAL