Sydney 2008 March Breaking bad news 60 yrs old her In greece came for check up and you

examined her, on examination you found that her heart s enlarged and you did an X - ray and on X- ray heart seems normal but Sver is found to be enlarged so you ordered CTscan, reasufis have come today and margarate has come to talk to you about the results. Task talk to the patient and interpret CTscan After greeting 1 started talking to her that we havegct the result of your CT scan today Then i showed her that them are some suspicious tescsws in her CT Iwer we called and gradually told her that ft could be something nasJy that might have come here from somewhere else like bowel pancreas, fiver Itself, then patient asked me what are you going to do now.and i tofd her that we are going to do the Biopsy which ts to take a smait pteee of tfesuse from here and analyse it in the lab to find ut from where it has came and accordingly we will plan for the treatment Then the patient asked me that she is going to Greece in 2 weeks time. I advised her that i wilt check with the radiologists t do biopsy early and also do some blood test like Tumor markers as early as possible and its better if she wail for the diagnosis to be' confirmed first and {hen you can plan for your trip easily Examiner asked me what are the test you are going to do before fiver biopsy and what are the tumor markers you are going to do?

Acute psycosis 25 yrs old university student came to your general practice because of wrist cut injury which he does not know how he got that, Nurse has done the bandage and during history you found out that he is also taking some sort of drugs, he has some work problems and hallucinations and delusions . He is paranoid also. He has no insight as well He is not suicidal and is living with his classmate in a shared room. No other medical problem as such. After bandaging you need to talk to him about management. No more histroy or examination . Talk to him about management I just talked to him about my diagnosis is acute psycosis and why i am thinking so . I told him about some reasons of acte psycosis and what i am going to do .\ told him as well as examiner about management which is to do invalunfry admission and which is by activating the mental health act NSW. In hospital some blood test will be done to check which drugs he is taking and also psycitrist wiil also do assesment and accordingly further managment will be done. Secondary PPH

A 25 year old mother complain of dizziness after second delivery. task take history .examination finding from examiner and manage

in histroy patient whole pregnancy was alright .delivery was alright .baby was fine, episiotomy wound was ok. After delivery bleeding gradually decreased but for one day it started again not associated with pain or cramps or fever. She didnt pass any clot, not on any medication or bleeding problem . She was breast feeding . good family support, no history of trauma. This was second -delivery.. First delivery was ok. Delivery was in hospital. Examination findings were all ok except uterus was 2 cm below the umblicus, non tender, firm . no adenexal tenderness. I explained to her about the diagnosis and told her the reasons as well . Then I just said that in your case your womb is still big so i need to send you to hospital to find out why is it big . over there USG will be done and ergometrine will be given and if necessary D&C will be done .Obstrafician will look her as well, and btood test will be done. CVS examination

/ Respiratory examination 25 yr old man complaining of dry cough for 6 weeks started after chest infection. Father has history of hay fever, patient himself has no known allergies. Task Do respiratory examination in 4 min Ask for investigation finding Tell your diagnosis

1 performed respiratory system examination from tally book then examiner asked me my findings which i told are normal, then she asked me about investigation and i asked about spirometry which showed 15% improvment in FEV1 after the bronchodilater. and i told about the diagnosis as Asthma . </ Osteomylitis/ septic arthritis

A 12 month old child has come to you with histroy of refusal to walk for one day. Father has come to talk to you Tsf&k take histroy ,ask examination finding, manage

In histroy child has been sick for about one day with fever and refusal to walk as well as feeding tess than usual. mother recorded her temperature which was 38,5 F No vomiting, no rash, no injury, no history of contact with any other person having infection, not drowsy, 2 weeks before history of URTl .two other kids at home who are healthy and fine, no history of any allergies. Al! pregnany details were ok,, healthy child so far except for this problem today. Immunization up to date Examintion child is irritable, feverish 39F knee is swollen red warm restricted ail movements, no rash no neck stifness .throat is ok managment I totd to the father that his child is sick and we need to admit him in hospital, he might have got infection of knee joint of he might have got infection of bone we call osteomylitis. It is very important to start him on antibiotics and do some blood test like FBC and culture, ESR, CRP and bone scan and if necessary specialist might do joint fluid aspiration and culture as weil to make sure. Father ask about how much he has to stay in hospital and how long will be the antibiotics will be given to him, what are the complications involvedPyloric stenosis

5 wks old baby presented with history of vomiting . Task take history examination finding from examiner and manage

On history child has two weeks of vomiting and vomitus contains only breast milk, not greenish, no blood and comes immediately after feed, child is now passing less urine and less bowel action as weli. No fever, not drowsy but irritable child . mother takes care of the child herself and he deosnt go to daycare. there is another child with history of gasteroentritis 2weeks before. Pregnancy details are fine .immunization is uptodate. Examination finding child is irritable ,no depressed fontenelle no sign of dehydration, no rash , vitals normanl. abdominal examination is not possible because child is crying .then i asked that i want to observe how the child vomits after feed and examiner ask that vomitus is forceful and child cries after that Management I told the mother that child might have got a problem we called pyloric stenosis and drawed diagram for that. Told her that child needs to be admited and assesed by peadratrician , in hospital child will be necked .electrolytes will be balanced then once stable will be operated we called pyloromyotomy. Case is from AMC books and all questions asked were from book. Child Abuse

1 yr old child came with histroy of roll over injury and brusies on face and is irritabe and crying for one day.Parents are uni students 23 & 24 old , height and weight of child dropped from 50th to 30th . You have assesed child and talk to parents about management. Task take further history and manage

SO i asked about pregnany details which was unplanned but otherwise without any significant problem, birth weight was 3.5kg .child was breast fed up till 2 months then bottle fedimmunization s up to date . no problem before, parents were uni students . no financial support, no social support, both parents smoke, drinks vodka, marruagna smoke. I just told mother that as your child has rolled over injury so I am concerned about health of your baby and we need to admit him and do CT scan as we need to rule about head injury, mother became furious and said to me are you saying that dont take care of my child .then I told her that I am not commenting on your parenting I am just telling you how we need to take care of your child and he needs assesment from peadiatrician. Then she said that his father will be very angry when he came to know this all and i wont take her to hospital. then I just said that i need to inform to DOCS and send your child to hospital and bell rang.

/ BPH(AMC) 58 yr old man came with history of urinanry problems . Task take history and examination finding from examiner do investigations and tell your diagnosis and management

Gout fromAMC talk to patient about gout and manage

Aute Inferior Myocardial Infarction f r o m A M C Take relevant history do investigation and tell your diagnosis JLe hU, c^-J ^4 ft tew

Irritable bowel syndrome take a psychosocial histroy and manage

Patient was flight attendant , anxious personality, all investigation done and specialist told her that she has got irritable bowel syndrome and she has come to talk to you about diagnosis .she has some family problems as well as problem with his boy friend and work problems as well. so I explained about irritable bowel syndrome and managment as well as psycosocial managment

Ectopic pregnancy 4 weeks before patient was diagnosed with ectopic pregnancy and laproscopic removal was done on left side , right side is ok. BHCG is 15000 at that time. tatee a relevent histroy and answer her questions

In history this was patient first pregnancy and before that she was on OCR and single partner for 10^fs. Menstural details were ok . past history of some sort of infection was ther but no investigations were done for that, no history of pelvic surgery.no family history of endometriosis or afiy^thing else.pap smear was normal. So rdraw a diagrm and explained about ectpoic pregnancy and told her that it could be infection 3o i will do BHCG and Vaginal swab and check it out. told her about that other tube is fine and tesSthy so she can get pregnantagain but chances of ectopic pregnancy are increased .she asked me about how she can know about ectopic pregnancy and i told her as yout periods are regular so tf-u misses even one day check it out or come to me and i will check for you . some time there are *yfnptoms and some time not but when you think u miss your period come .then she asked about hat are the other ways of treating ectopic prgnancy. Testicular swelling 25 yr old man came to you to know about the USG results done last time because his left testicle side seems to be more prominent than other .USG results shows some homogeneous echogenic foci

TeW the patient about the results and talk to him

i told about the USG finding and told him about suspicion of cancer which could be seminoma or teratoma but seminoma is more cmmon and told him about futur managment. I told him that i am going to send him to surgen for surgery and told him about it will be done, he need to do self testicular examination and come for regular follow ups as well. after staging further managment will be palnned which could be radiotherapy .patient asked me about prognosis and further follow up . asked about his fertility which i told will not be effected much and during therapy we will store the sperms .examiner asked me about whether we will do FNAC or not and why, I told we will not do it because of pread of cancer to other lymphatics.

Tiredness and Fatigue 42 yr old baker presented with 2 months history of fatigue and tirdness . take history in detail take examination finding from examiner tell your diagnosis and investigations you want to do no managment

I took a detailed history to rule out other causes of tiredness . patient said no to every question except that past history was positive for dental extraction 3 months before examination finding were only positive for pan systolic murmur and splenomegaly I told examiner that my diagnosis is Infective endocarditis and told about investigations I want to do which were FBC and Culture ,ESR,CRP,ECG,Urine complete and cultre.Echo

Dysfuntibnal uterine bleeding

12 yr old girl came with bleeding history for about 10 days . ist period . take history examination finding from examiner and manage

ON history it was first period and she has been bleeding for about 10 days .quiet heavy, no passage of Clots, no pain , no fever, no discharge, no family history of bleeding disorder, no medical or surgical problem, no thyroid problem, no medication usage, not sexually active, mother started having periods in same age and sister too but none have got this kind of problem . I asked examiner about examination finding and every thing was ok . BP 100/60 pulse 100 /min temp normal no abdominal findings pregnancy test negative I told mum about Dysfunctional uterine bleeding and also other causes as well, so we need to admit her in hospital start some I/V estrogen then progesterone tablets 14 days . side effects of medications as well. obstretitian will check here and might put her OCR for 6 months .MUM asked me about any other medication beside OCP the i told her that yeas we do have mefenemic acid and trenxemic acid but they are not as effective as ocp in regulating the hormonal axis . then she agreed . I told about list of investigations that we need to do in hospital.