To ReviseAug 22 Adelaide

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08/22/2009 Adealide recall

Psychiatry

1. Somatoform disorderA middle aged lady came to your GP complaining of heart fluttering, all Ix normal, including

ECG, ECHO, Hoter monitoring. The lady is your Pt for 10 years, sees you on and off for

headache, abdo pain, back pain, etc. She recently separated from her boyfriend as he finds a new

young girl friend.

You did a PE on her: BP 130/80, HR 80, others NAD.

Tasks: Counsel her

No further Hx and PE

AMC feedback: Somatisation disorder

Explained somatoform disorder, how mind and body connect with each other. Suggest relaxation

technique. Follow up etc.

2. Mini-mental SE

You are a intern in Psy ward. A medical student approach you with a MMSE result he just done

for a Pt with moderate- severe degree of depression.

Tasks: Explain to the medical student the MMSE results

Answer his questions

When I came into the room, the role player handed me a sheet of MMSE: total score 18/30,

orientation 5/5, registration and recall 0, concentration 0, last two question 0.Questions from role player:

What is the total score 18/30 mean?

Can I Dx her dementia from the MMSE?

Can I exclude Delium from the MMSE?

She didnt finish the last two questions as she said she is too tired to do it. Can I score the last

two questions as zero?

AMC feedback: Teaching a Folstein MMSE

O&G

1. A young primigravida came to GP for anti-natal checkup. It is the 2nd time. During 1st

checkup, you did some Ix, results back now: Rh negative, all the others normal.

Task: counsel her

Old case same as previous recall. Role player is very worried, need a lot of reassurance.

AMC feedback: Rh negative

2. A young lady came to GP because no period for 12 months. Previous period normal.

Tasks: 1. take a history for 6 mins


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2. explain to her the possible cause and Ix needed.

Need a full history to find out the reason for 2nd amenorrhoea. When asked about previous preg

history, role player said she had a miscarriage 12months ago, had curettage and complicated by

infection. Therefore could be Asherman syndrome.

Role player Qs: Can I get pregnant in the future?

AMC feedback: 2nd amenorrhoea

3. A primigravida, 30weeks pregnant, came for antenatal checkup. Bp 170/110, urine protein ++

+.

Tasks: 1. take a history

2. PE findings

3. Ix

4. Explain Dx and Mx

Same as old recall. Hx no significant findings. PE: ankle edema +, reflex active, no clonus.

Explain need immediate admission to hospital by ambulance, and explained the Mx in

hospital.

Role player Qs: Will my baby need to be delivered immediately?

AMC feed back: severe pre-eclampsia

Paediatrics

1 A 3-4 yr old boy was admitted to paediatric ward due to diarrhea. He was put on oral

hydration and condition stable now. You are the RMO. Lab just called you as salmonella

was found in the stool culture. There are two other children in your ward that have

similar diarrhea.

Tasks: Take a history from mum to find out the reason for diarrhea

Explain Dx and Mx

Hx: the whole family is on holiday. Cooked food for themselves and drank tap water.

One younger sister at home, no symptoms. Other family members OK.

Explained what salmonella is and how it is transmitted. Reportable disease. Follow up by

GP, chronic carrier state, etc.

Qs from role player: How long do we need to be precautious about the infection risk?

Need antibiotics or not?

How did he get it?

AMC feedback: bacterial gastroenteritis

2. Picture of face of a child, showing swollen lips and rashes on face and neck. Child condition

is stable, swelling better now. No difficulty with breathing. Mum is here in your GP.

Tasks: Take a history

Immediate managementLong term Mx plan


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Hx: The child had a sandwich yesterday which contains peanut butter. Strong family Hx of

atopy. Have a sister at home.

Mx: steroid tablets

Anti-histamines

Long term: Epi-pen, action plan, refer to allergy specialist.

Role player Qs: Can he grow out of it?

AMC feedback: Allergic reaction ( peanut allergy)

3. A mother came to GP clinic and asked you to see his 14 yr old son as she thought that he

might be able to talk to you rather than her. The boy was admitted to hospital repeated

recently due to poorly controlled type 1 DM.

Tasks: engage the boy

Find out the reason for his poorly controlled DM.

Mx

I failed this station. Plz refer to the candidates who passed this station.

AMC feedback: poorly controlled DM in 14 year old

Med &Surg

1. DM lower leg examination

Same as old recall.

AMC feedback: DM type 2

2. Post traumatic rupture of rotator cuff (AMC feedback)

Same as old recall.

A young lady suffered from severe shoulder pain right side after lifting a 20kg carton at

supermarket.

Tasks: Do shoulder Ex

Explain Dx, Ix, and Mx

3. A old man had a sudden onset of one side weakness and numbness, dysphasia, no one side vision

problem, for 15 mins. Symptoms still present now. Bp 200/100, pause 80. You are an intern in the

ward. The wife is here to ask you about her husbands condition. Pt had a pace-maker inserted for

CHB previously.

Tasks: Explain Pts condition to the wife

Explain the reason for the presentation

Further Mx plan

Qs from role player: Why is this happen?

Can he recover from it? When?

How do I look after him when D/C?

Examiner Qs: are you going to lower the BP?

Why cannot lower the BP down to normal?What meds are you going to give?


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AMC feedback: Acute stroke

4. Book case: abnormal liver function test in long term alcohol use

Same as in the book except that you need to take a history.

AMC feedback: Alcohol abuse.

5. A 48 year old lawyer came to your GP clinic as he suffered from crushing chest pain and fainting

recently.

Tasks: take a history

Ask for PE findings

Explain Dx and Mx

Hx: typical ischaemic chest pain. When asked about fainting, role player gave a typical description

of postural hypotention. Then asked SOB, which is positive. No orthopnoea, no ankle swelling.

Black stool for one week. Then asked cardiac risk factors: father died of AMI at 52, smoking 2

pack a day for more than 30 years, drink 6-8 standard drink a day for same period of time.

PE: pale, P 110.

Epigastric pain, liver enlarged. PR: malena stool.

Explain alcohol cause inflammation/ ulcer of food pipe and stomach, which cause bleeding. That

blood loss cause anaemia, which triggered ischaemic chest pain and cause fainting.

Need admission and further Ix

Bell rang before I finished.

6. Picture of a lower leg of a 58 year old man, showing irregular red patches, typical for cellulites.Tasks: take a history,

Explain Dx and Mx

No PE needed.

Pt did a lot of gardening last few days. No obvious injury. Excluded DM, immunosupressed,

venous problem. Positive for PVD.

Mx: admission, IV ABS, bed rest. When infection controlled, Doppler U/S for arteries. Life style

modification, etc.

Qs: Can I take oral antibiotics? I dont want to go to hospital.

AMC feedback: lower limb cellulites

7. AMC feedback: papillary cancer of the thyroid

Same as previous recall.

8. Book case: renal colic

Same as in the handbook, except that the pt had three previous episodes within one year.

When asked for Ix, examiner handed to me a CT scan, which showed a 3mm stone at the

vesicoureteral junction.

Good luck for everyone!

Documents

To ReviseAug 22 Adelaide