11th February 2014, Melbourne NTC (morning group) Recall
Pediatric cases:
(1)You are a GP. A mother brought a 3 years old boy who has sore mouth. Picture is given showing some ulcers and blisters & some darkish discolorations on his lower and upper lips with some redness.
Tasks: Take relevant history. Ask PE findings from examiner (u maybe given specifically for what u ask for). Tell the (Dx) Diagnosis and Mx(Management) to the mother.
Positive findings on H/o : sore mouth for 3 days, a bit febrile, drinking well
Positive findings on PE: Temp- 37.8, others- stable, Mouth ulcers- as shown in the picture
My Dx- Herpes stomatitis
(2)You are a GP. A mother brought a 5 years old boy due to some rash and swollen lips. Picture is given showing rash on neck and lower face with swollen lips.
Tasks: Take history. Explain the Dx to mom. Tell her about immediate management. Also tell her about further management.
Positive findings in H/o: swollen lips & rash appear after having breakfast, which includes peanut butter spread sandwich, this is the 1st time, rash seems a bit itchy, no other positive findings in the boy. Family history- his elder sister used to have eczema when she was young.
Facts: No epipen was given there to explain mom when I asked the examiner.
My Dx- Peanut allergy (mild to mod)
(3)You are a GP. A mother brought a 6 weeks old baby girl because a local health nurse suspects some problem with the baby’s hips. She was born at term by elective CS and there was no complication during pregnancy or labour. Mom gives a history that her niece also had some problems with her hips when she was born.
Tasks: Perform focused PE . Summarize the findings to mom. Give your Dx to mom. Give her the management plan.
Facts: they will provide u a half body dummy of a baby to perform PE (u will get a clicking sound on abduction).
Dx- (should be) DDH.
Obstetric cases
(4) 32years old 37weeks pregnant female presents to your GP with headaches. She regularly visits your clinic for followups. A week ago when you saw her, she was having some swellings of her legs. All the investigations done throughout the pregnancy have been normal.
Tasks: Take relevant history. Ask PE findings from examiner(specifically) . Give your Dx to her. Talk about immediate management and also further management to her.
Positive findings on H/o: headaches for about 2/3days , here and there on her head, 5 out of 10, she was having headache during the consultation, so I prescribed some pain killer. No visual disturbance. Swelling of both legs was present. No other significant findings.
Positive findings on PE: BP- 180/110, RR- 20/min, others within normal limit, fundoscopy- normal, reflexes- hypereflexia, obs exam: everything normal, FHS- normal, Inspection of Vagina and Speculum exam- all normal, os still closed.
Facts: While I was explaining to my patient, examiner interrupted me and said “patient is now having fits, what are u gonna do?” . Then, he asked “ what specific BP lowering agents do u want to use?”
My Dx- Severe Pre-eclampsia with impending Eclampsia.
(5) 34 years old female wants to get pregnant. She has been diagnosed with epilepsy for over 15 years. She has been on Na valproate and is stable with her symptoms for 2 years now.
Tasks: Take history. Advise her on getting pregnant and how you will manage the case.
(6) 30 years old female with some vaginal bleeding came to your GP.
Tasks: Take history. Ask PE findings (specifically) . Tell the patient of your provisional Dx and your management.
Positive findings on H/o: Bleeding per vagina for 5 months, noticed during the middle of the cycle everytime, no clots (she said she didn’t know about amount or color), No other symptom at all. LMP was 4 weeks ago (she said it is supposed to be her period time now), she is married and they are trying to get pregnant , so, she stopped using condom about a few months ago. Pap smear- normal 6 months ago.
Positive findings on PE: with consent and on vaginal exam- cervical eversion was present. No other positive findings, no pallor.
Facts: I wasn’t sure if this bleeding was just due to cervical eversion because she said it was always in the middle of her cycle.
My Dx- Mid cycle bleeding due to ovulation plus cervical eversion
Psychiatric cases
(7) (station 7) You are HMO at ED. You are about to see an 18 years old girl who had a cut in the right elbow which is quite deep. The nurse has taken care of her wound already. She is about to be discharged but before she goes home, the nurse wants you to review the patient.
Tasks: take relevant history from the patient. Tell the examiner what risks she has and report the examiner about her mental state regarding mood, insight and judgement.
Positive findings: Didn’t have any suicidal ideation. This cut was the 4th time. This time she did this because she was extremely upset by her friends for not showing up on time at the pub. Mood was Ok, Insight was impaired (she thought she didn’t need any help at all from the doctors) , Judgement was fine.
(8) (station 19) You are a GP. You are about to see a middle age lady. She had sever depressive episode with some visual hallucinations of seeing snakes everywhere(long stem giving all the criteria to fit as a major depressive episode) a month ago. She was admitted for one week in the hospital and had ECT at that time and then after that, she has been on Mitrazepine and Resperidone. She comes to see you for follow up.
Tasks: take relevant history. Perform focused PE on Upper limb only. Tell the patient about your Dx and Mx plan.
Positive findings in H/o : From the start of the consultation, I can see that the patient has pill rolling tremor on both hands. She has tremors about a week ago or so. Her mood has been better now and no hallucinations, no suicidal ideation.
Positive findings on PE: pill rolling tremor on both hands, rigidity present on both upper limbs. Power, reflexes are normal. Problem with tapping the fingers on the table. Mircographia present.
Facts: They provided a hammer on the table.
My Dx- Drug induced Parkinsonism
Medicine and Surgery cases
(9) You are a GP. A patient comes back to you to discuss about her Spirometry results. The result paper was given at the door, both pre and post bronchodilator.(it was a long stem with signs and symptoms of COPD case)
Tasks: Explain the results. Tell the patient regarding the Dx and Mx plan.
Facts: No inhaler or spacer was provided there when I asked.
My Dx- Chronic obstructive airway disease (confirmed Dx with spirometry)
(10) You are a HMO at ED. A middle age man comes was brought to ED one hour after a MVA. (sorry guys, it was a long stem I could not remember). A picture of his lower legs was provided,showing redness and abrasion and sort of like an open wound on overlying skin and also one Xray of the tibia and fibula of left leg showing comminuted fracture of tibia and also fibula.
Tasks: Explain the Xray result to the patient. Perfrom PE on his LL focusing on complications of such condition. Tell the patient what your findings are. Talk to the patient about the Dx and the immediate management.
Facts: u will get an extra copy of Xray and picture inside. You will be provided with cotton wool, pin prick, hammer. There wasn’t any neurovascular compromise but the patient was in sever pain. His left leg was covered by a bandage. I had to look at the picture and described the findings on PE. Examiner interrupted me twice ; “ what are u gonna give specifically for pain killer?” and “ what type of fracture do u suspect?”
My Dx- Open fracture with comminuted bones of both tibia and fibula
(11) You are HMO at ED at rural hospital. A middle age man presents with all the typical symptoms of MI. This is the 1st time he is having chest pain. You cannot contact specialist at the moment. ECG was given showing ST segment elevation in lead 2, 3, and aVF. His wife has come to talk to you.
Tasks: Explain the ECG result to the wife. Manage the case accordingly and tell the wife about it.
Facts: patient’s wife was so damn worried, I had to reassure a lot. While I was talking to her about the management , examiner interrupted me with “ where exactly is the problem in his heart?” eventhough I had already mentioned the wife about inferior part while explaining the ECG. So,I drew her again and showed what inferior of the heart was.
My Dx- Acute inferior MI
(12) You are a GP. 35 years old male presents with low back pain after lifting a heavy box.
Tasks: perfrom PE. Tell the patient what you are doing throughout your performance. Tell the patient about your findings. Give DDx to the patient and why.
Positive findings on PE: Pain on walking both tip toe and on heels and squatting. Localized tenderness on S1 vertebra and also paravertebral tenderness on right side of the S1 vertebrae and patient said pain presents along the back of thigh when he walks. Examiner told me to skip Schober test and slump test when I was about to perform. Sensation was normal. Reflexes were also present. Power was a bit reduced on right side of the leg.
My DDx- Sciatica due to prolapsed intervertebral disc and Mechanical low back pain ( had to explain to the patient what these Dx were).
(13) You are HMO at ED. 20 years old male presents with pain (describing acute appendicitis) with nausea and vomiting. PE findings were given- Fever present. Tenderness at RIF. Rovsings sign present.
Taks: Explain your Dx and possible DDx to the patient. Take any further relevant history to get to your definitive diagnosis. Tell the management to the patient.
Positive findings on history- just as appendicitis and I ruled out renal stone and GE.
My Dx- Acute appendicitis . My DDx- right renal colic and Gastroenteritis.
(14) You are a GP. A 55 years old patient with type 2 DM was on OHA but it wasn’t under control so, his physician decided to start him on insulin about 3 weeks ago. Now, he is having funny turns and sweating and tired since this morning. PE findings were given and all looks stable.
Tasks: History from patient. Ask most important bedside tests and Investigations that you want from examiner . Explain the Dx and Mx to the patient including how to prevent it next time.
Positive findings on history: funny turns and palpitations and sweating since this morning, 1st time ever. Was Dxed with type 2 DM for many years. Bedside random BSL result- 3.5 (I think), UDS- nothing positive.
My Dx- insulin-induced hypoglycemia
(15) You are a GP. A 58 years old female presents with pain in the right calf.
Tasks: Take relevant history. Ask PE from examiner. Talk to the patient about the possible Dx and Investigations that u you would like to do.
Positive findings on H/o- pain on walking, progressive and now cannot walk a certain distance as she used to, relieved by stopping walking and rest, no swelling, no pulmonary embolism symptom, she smokes for about 25 years ( I cannot remember the details of smoking).
Positive findings on PE- Burgers test positive on right side , ABI ( examiner said cannot get at the moment)
Investigations- Doppler USG and angiogram and BSL, lipid and basic blood tests.
My Dx- Intermittent claudication due to peripheral vascular disease
(16) You are a GP and 50 years old male patient came back for his results on LFT – MCV increased, Hb normal, rGT increased. He came last week to see you because he has seen a TV programme about alcohol drinking.
Tasks: Explain results to him. Take relevant history esp: on his drinking behavior. Give Mx plan to him.
I have already passed the exam but I am still waiting for the amc feedback. So, I am not 100% sure of my recalls at the moment. However, I tried my best to write it down for everyone of you who are going to sit the exam in near future or far future. I hope my recall gives some help to you guys.
All the best to everyone!!!
Thanks a lot to all my study partners and my friends who supported me all the way and also ,of course, to my tutors from the AMRC course.