19th May,Sydney 2007 Clinical exam full feedback

Discussion in 'AMC Clinical Exam' started by Dr_Autumn, May 25, 2007.

  1. Dr_Autumn

    Dr_Autumn Guest

    Hello everyone,

    Thanks a lot for your heartly congratulations.I have written a feedback after clearing the exam.Hope that will help you guys.

    Medicine & Surgery

    (1) A 35 year old lady came with breast pain. It is related with her periods. Examination finding is normal, lumpy feeling allover the breast, no localized lump found. No palpable lymph nodes, The USG finding is normal. Her mother was diagnosed with breast cancer at the age of 50. The patient is worried of getting breast cancer.
    Task: Take history, explain and manage, order any investigation needed.

    It was my first case. I entered the room. Greeted the role player and the examiner. First I smiled and told the lady, Mrs.X there is good news, you don’t have cancer, so don’t worry. She asked, are you sure it’s not an cancer? I said, upto what I have found so far, it doesn’t look like cancer. She was happy with that and said, Oh, that’s a great relief!! I started taking history- Breast Pain before or after menstruation, menstrual history, Diet history (She drinks 4 cup of coffee and 2-3 cigarettes/day), Contraception History, and any bleeding, pain, fever any other concerns, alcohol, when and how her mother was diagnosed with cancer. She asked, I am worried as my mom has diagnosed with cancer, will that happen to me? I said I appreciate your concern; yes you have higher chance of getting breast cancer other than normal population. What you need to do are some simple things. Then I explained about self-breast examination, how to do it the procedure etc, I drew a picture to explain her. If you found something lumpy then seek medical attention. I mentioned about regular screening like, mammogram and USG.I explained-the condition you have is called cyclical mastalgia. It’s a benign breast pain due to hormonal imbalance during periods. There is nothing to get worried about it. Just relax, reduce caffeine and smoking, wear proper under-garment, if weight is a problem, reduction can give some benefit. There are some medications such as Mefenamic acid, Vitamin B, Evening Primarose oil. The patient asked, the lumpy feeling I am having, can these turn into cancer? I said, not really. Because cancer is a different thing that occurs when some cells start growing abnormally. I told, I will give her some reading materials. At the end I told, if you have any concern, please feel free to discuss with me. The bell rang. Patient said, Good luck doctor!! Examiner kept quite.


    (2)24 year old man, working as computer analycyst, has history of Bronchitis, getting treatment for that. Smokes 30 Cigarettes/day. He wants to quite. He tried before cold-turkey method, it didn’t work.
    Task: Talk to him regarding quitting smoking and find his level of Nicotin addiction, counsel and discuss treatment options. Smoking counseling


    I greeted the role-player who was an Indian guy. First I told, Mr.X I appreaciate that you have taken the step for quitting smoking. I asked history-when he started smoking, any frustration in life, Alcohol, any recreational drugs, work stress, any physical symptoms and craving when he don’t smoke. He said, everything is fine, he wants to quit as its making his bronchitis worst. He also mensioned, if he didn’t smoke for a while, he starts craving. I asked him, if I grade from 0-10, where 0 is lowest desire and 10 is highest desire, where does he put his desire to quit smoking? He said, he really wants to quit seriously, so its 8-9.I said, that’s really good. I told him things such as- avoiding smoking company, pick up a nice hobby, and eat healthy, Quiteline and nicotine pathes.I also mensined,cold turkey method didn’t work for you first time, but you can still try once more, that’s an option as well. He asked, if he quit smoking will his bronchitis go away completely? I said, it won’t go away totally, but it will really reduce the symptoms and course of the disease and you will feel a lot better. Because smoking affects the lung lining. The bell rang. The examiner was a lady and didn’t ask me anything.

    (3) A 25 year old lady had a baby few days back. She is complaining of not hearing well.
    Task-
    Take relevant history.
    Do an ear examination.
    Explain to patient and manage accordingly.

    I started taking history-post partum depression, how she is coping with the baby, and any exposure to noise, ototoxic medication, tinnitus, dizziness, pain, discharge, Family history, previous history of Otitis Media. I asked if the hearing loss unilateral / bilateral, when did it start. She was coping well with the baby, no pain or discharge. Family history was-positive, her mom has some problem in ear and uses hearing aid.

    I did ear examination-Inspection of ear, I said I would like to do Autos copy. Examiner asked, what are you looking at autoscope? I told I shall look for tympanic membrane, mobility; translucency, auditory canal, and any fluid or pus etc.Then I did rub test (Whispering to one ear by distracting other ear) Rinne’s test and Weber test. All were positive for conductive type of deafness. I explained the patient that you probably have a condition called autosclerosis.In this case, normal ear bones are replaced by spongy vascular type of tissue.So, the sound waves can’t transmit from the outer ear to inner ear. I need to refer you to a specialist and other test needs to be done such as Audiometry.The specialist can offer you treatments such as stapidectomy,hearing aid (which don’t have long lasting benefit).The bell rang just on time.

    (4) A 34 year old man came to the emergency department having chest pain. The pain is radiating to his back, jaw and shoulder.
    Task-
    Take relevant history.
    Examination finding from examiner, order investigations.
    Tell the provisional and differential diagnosis.

    I entered the room and asked Mr.X, are you all right to talk? Is the pain too much? He said yes, I am having pain. I said; would you like to lie down? I am giving you some pain-killer. He said thanks. I took a quick history- Is the pain first time? Radiation? Releaving and aggravating factors? Family history? Indigesion? Heart-burn? History of-Hypertension, Diabetes, heart disease, peptic ulcer? Breathlessness? Smoking / Alcohol/ Any Medication?
    The patient was having pain for the first time and breathing makes it worst. It’s also radiating towards the shoulder and back. He didn’t try any medicine No family history, no hypertension, Diabetes. No loss of consciousness or Vision problem as well.

    I asked examination finding from the examiner- General appearance-In pain, Vitals-Normal, Cardiovascular examination-no murmur, heart sounds are normal, a hazy sound at apex area. I asked-Is that rub? Examination replied, yes, it sounds like a rub.Respiratory, abdominal system normal. No odema.Investigation-not available, you have to order.
    I said, Mr.X, most likely you have a condition called Pericarditis.It happens when the covering of heart get inflamed. I drew a picture. The D/D could be Myocardial infarction, Angina, perforated Peptic ulcer. I will order some investigations such as-ECG, Cardiac Enzymes, Chest X-ray, and other-blood-glucose, Urea&Electrolytes.Meanwhile I will give you pain-killer and arrange investigations and will go from there. Is that all right? Patient said, that’s fine. I added, as you have chest pain, we are taking this seriously and can’t rule out other causes without further investigations.So, we are going to do those as soon as possible. Examiner didn’t ask anything rather than giving examination findings.


    (5) A 45 year old man have a swealling at his neck( Parotid region)-PICTURE WAS GIVEN.
    Task- Take history
    Do examination of the lump/Relevant examination
    Diagnosis/Differencial diagnosis
    Investigation & Management (I don’t remember clearly if there were investigation and management included)

    The role player was a man, who wasn’t a real patient. I took history-when did the lump appeared, any pain, wt loss, fever, any other physical symptoms. The tumor was a slow growing, painless swelling. No numbness, tingling over the face, no ear pain, no hearing problem. On examination I was about to look, the examiner stopped me and asked what I should I look for. I said, the size, shape, consistency, mobility, fixidity of the swealling.What else? Surrounding lymph nodes. What are those? Submental, submandibular………..what else? Neck examination, Thyroid, Facial Nerve. What else? I didn’t know what to say. I don’t know what else he wanted. I spend too much time answering his quires. Then he asked whats the diagnosis? I said-Provisional diagnosis is Pleomorphic adenoma, Differencials are Lipoma………..and the bell rang. I couldn’t finish the case.
    I think I didn’t do well this station. Please take feedback from other candidates.

    (6) A 30 year old lady had calf pain after a long trip from Europe. Doppler confirms DVT -multiple clots along the leg.

    Task- Take further history, explain to patient.
    Management.

    I entered the room and asked the patient how she was doing. She was ok. I asked her-Any family history of DVT, Recent surgery, smoking, how often she travels, OCP or any medication, any medical condition. Everything was fine. I told-well Miss X, we have done some tests which show you have multiple clots in your leg, we call it DVT.I explained what DVT is. I told, you need to get to admitted to hospital immediately. She said, what will they do in hospital? I explained they are going to put you into Anti-coagulant. Before putting to anticoagulant we will check for pseudoplhebitis. She was a well prepared role-player, she actually asked me everything regarding anticoagulant even I/V or oral rout. Then I mensioned everything,doses,which route, monitoring APTT,INR-coagulation profile and then continue Warferin for 3 months atlease.She needs to mension she is taking anticoagulant before going for dental extraction or any procedure. I told her about elastic stocking and foot exercise, ankle pump and safely walking at airplane next time when she travels. She asked, should I wear stockings now? I replied, well, not now, I am just telling for the future prevension. Now you need medical treatment urgently. Patient asked, Is it serious? I said, yes, it is. Because the clot can dislodge and go to lungs causing serious consequences. The examiner kept silent. Bell rang just in seconds.

    (7) A young man, 27 year old complaining of Groin pain. He is a soccer player.

    Task- take history
    Do relevant examination
    Tell D/D

    At history-he is a soccer player, he don’t remember hurting himself. Just having pain in the inner thigh region. Pain localized, not radiating. Then the examiner asked me to do examination

    I did hip examination. Checked muscle power, movements, sensation. He had weakness at adductor muscle-group. I wanted to do Trendelberg test and neurological examination but examiner says no need to do it. I did mess up this case when the examiner asked me adductor muscle attachment. Honestly, it didn’t pop into my mind straight away. Then he asked the nerve supply of adductor muscles. The only thing I remembered was dermatomes!! The D/Ds I told tendonitis, muscle strain. Nothing was coming to my mind that time. So this station didn’t go very well for me. Check it with other candidates.


    (8) A 40 year old man complains of vague ache and pains, generalized tiredness for 2-3 months.

    Task-
    Take history
    Examination findings from examiner
    Investigation and D/D

    I started my station by greeting the patient. History- when did it started? Bowel/waterwork, any bleeding? Vomiting, fever, rashes? Weight loss? Tummy pain? Palpitation? Depression history? Smoking/Alcohol? Tanning or discoloration of skin? Any preference for hot or cold? Drug, Medical condition, family history of cancer? Overseas travel?
    He gave me history of traveling to Malaysia, Weight loss, mild fever with night sweats, runny nose. No sexual exposure, he didn’t have street-vendor foods. He had malaria prophylaxis before going to Malaysia. I asked, are those symptoms before or after returning from Malaysia? He replied, those were actually before visiting Malaysia. I said, did you seek any medical attention? Then he grabbed a piece of paper and said he went to a doctor and he gave these Medications. It was “Doxycycline†and another I couldn’t recognize. I said, did you have any side effects or problem-such as rashes, vomiting, tummy pain after taking these medications? He said, no but I didn’t get better after taking these medicines. I was bit confused at this stage. I asked him regarding runny nose. He said he thinks its sinusitis. He doesn’t have allergic rhinitis or asthma. Now his only complain is generalizes malaise.
    I turned to the examiner for findings-General appearance, vital-normal, and no postural drop. No lymph node enlargement, Thyroid was normal. CVS, Respiratory, Abdominal all normal. No skin change or rashes. Investigations or office tests? Not available, you have to order. Now talk to your patient.

    I said, well Mr.X, there are couple of things coming to my mind. You may have post-viral fatigue, Influenza, Infectious mononucleosis, Hepatitis, Thyroid problem, Addison’s disease, Depression, Diabetes. I can’t rule out malignancy as you are having weight loss.So, I need to order some tests-FBC, Fasting blood sugar, ECG, Urea Electrolytes, Liver function tests, Urine Microscopy/culture, Chest x ray, Abdominal USG.If those test shows anything significant, more tests needed to be done…..the bell rang. No question from examiner.

    Psychiatry

    (9) A young lady, 32 years, has history of depression and phobia. She has been treated with Electroconvulsive therapy. She is currently on-Risperidone and Diazepam. Now she is complaining of tremor at hand.

    Task-
    Take appropriate history
    Examine relevant system
    Explain.

    I entered the room. The lady was in depressed mood. I started asking-how are you doing? Tell me how is your mood? Do you think life is worth living? Any hallucinations, delusions? Smoking/Alcohol? Recreational drugs? Whome do you live with? When did the tremor start, is it only in hand? Are you taking medications regularly, are you changing doses by yourself? Any dizziness, wt gain, insomnia? Any other physical symptoms?

    She had no suicidal idea; she said she wants to give life a chance. No hallucination or delusions. She wasn’t over medicating herself. No positive history except hand tremor.

    Then I started doing examination- she was having resting tremor and extended hand tremor both hands. At hand movement there was rigidity. After that I didn’t know what relevant system I should do. Then I did a mental state examination.Orientation, registration, etc.I am not sure if was relevant or not!! The examiner didn’t speak a word. Lastly I told, I think you are having the medication side effects. I will refer you to a psychiatrist as I can’t stop the medication, these medications has to be changed or replaced by specialists….the bell rang.

    (10) A 24 year man, mathemetics PHD student, who claims he has invented a powerful genetic revolution. His mother has history psychiatric condition and treated with ECT.

    History- Take psychiatric history
    Tell the provisional and differential diagnosis
    Explain the examiner what are the risks of this condition.

    I entered the room; the role player started talking before I started. He was restless and euphoric. He said, do you know what I have invented? I have invented powerful genetic coding that can cause a big change in the world, that’s amazing isn’t it? I was listening to him carefully and said, well it sounds interesting to me. But before that, can I ask you few questions? He said, sure, sure but quickly please, I have so many things to do.

    I asked- Do you see people or hear voices if no one around? Do u feel your thoughts have been taken away from your brain? Have you felt people spying against you or TV / Radio people talking about you? He said-no. How is your sleep? He said, he couldn’t sleep, he just thinks about his new invention. I asked about sexual activities. He is married with a kid. But he is having sexual activity with prostitutes. I asked if he is using condoms. He said, no he isn’t. I asked, does he like to spend money? He replied, he is planning to spend all the money he has. I also asked Smoking/Alcohol/recreational drugs etc.I asked Judgment and insight questions. He had lack of insight with intact judgment.

    At this point examiner asked me-what do you think he has? I said-Provisional Diagnosis is Mania, D/D-Alcohol withdrawl, substance abuse, schizophrenia, acute psychosis. Then examiner asked me, what you think most problematic thing in his condition? I said- He is having sexual activities with commercial sex-workers without protection. Which puts him at risk of having STDs and AIDS. He is married and his wife can also get infections through him. He is at risk of squandering money, which can put him into financial difficulty. He has a family with a kid; these things will affect his family’s economic solvency. He needs urgent Medical attention. The bell rang.


    Pediatrics

    (11)A mother of a 6 year old child came to you. The child is having right leg pain with fever 38.8 degree C. The child is limping.
    Task- talk to the mother
    Take examination finding from the examiner
    Manage.

    When I entered the room, the mother was really worried. I assured her that we will look after the matter. First I need to ask some questions. I asked-Did the child had any injury? Mom replied- he is trying to learn cycling and had couple of falls but they were not serios, immunization up-to-date, fever present, no vomiting, no tummy pain, no cough, limping and pain at right leg.

    I asked examination finding- General appearance-unwell, Vitals-Temperature 38.8 Degree C, BP, Pulse-rapid. Local examination- no swealling of knee. Pain at tibial border, local tenderness, all movemet restricted, gait-limping. No lyphm node swealling, Abdomen, chest normal. Genitourinary system (testes) normal. No investigations available.

    I said, mrs.X,your child is most likely having a condition called osteomylitis.Then I explained to her in layman terms.So,we need to admit him immediately so it cant spread to blood. We need to run more test. She asked what tests? I said, Blood-culture, X-ray etc.Mother asked, what are they going to do him in hospital? I replied, they are going to do some tests and start him on antibiotics I/V. Mom asked, how long he has to stay in hospital? Well it really depends how well he is responding to treatment, roughly around 7-10 days, could be more. She asked, after releasing from hospital, will he have medicines? I said, yes, oral antibiotics. Mother: Whats the complication? Blood infection, abcess, and sinus formation, limb deformity that’s why we are taking this matter seriously and will start treatment as early as possible. Don’t worry; we will look after your child. The bell rang. Examiner didn’t ask anything.





    (12) A 2.5 year old child having pale stools and diarroea.The child was treated for diarrhea but didn’t improve. His weight is below average. On examination-wasting of the buttock muscles. His father came to you; he couldn’t come for the baby’s regular check up as there was a death in the family.
    Task- Talk to father
    Mange the baby.


    I greeted the patient and asked how is the baby doing? He said, baby is ok but having diarrhea and not gaining weight. I told, there has been a death in your family, I am sorry to hear that. The patient said, yeah, that’s why I can’t come for my baby’s regular check-up. The patient was glade as I addressed his issues. I start taking history- premature baby or full term, any jaundice after birth, general health, chest infection, immunization, Vomiting, and bowel/wet nappies-everything was ok.The baby started having problem when they start weaning. The stool is pale and offensive. I asked any family history of celiac diseas.Father said, whats that? I said any diarrhea or tummy problem. Then he said, his brother has some stomach problem but he doesn’t know whats exactly that is.
    I said, well Mr.X, upto what I have found from examination and history, although we need to do more confirmatory tests, it looks like your child have condition called celiac disease. Then I explained him about coeliac disease as fro Patient education. He was very upset. He asked if it’s a lifelong condition or not? I said, it is, but there are so much options for food now-a-days. I told we have to do more blood tests such as –Antiendomycial and antigliadin antibodies. I will refer to a child specialist to do confirmatory test. He said whats the confirmatory test? I said Jejunal biopsy. He kind of jumped, Biopsy!!!!! Are they going to cut my child’s tummy? I said, well not really, sometimes biopsy can be done without opening the tummy.Dont worry,Mr.X your child will be in expert hands, they will handle him with maximum attention. If you want to know more about biopsy, I shall give you some pamphlets or talk with the specialist regarding the procedure and let you know. Does that sound ok? He was bit calm then. He asked, are you sure my baby has celiac disease? I said, we can’t be 100% sure until the blood reports are positive, so more tests need to be done. I said, what foods should be avoided in Coelic disesese such as wheat, barli, rye, oat.He asked, should I not give him those from now on? I said, well I will order blood tests and until the result comes it wont be any harm if you avoid those foods, then we will see what happens, all right? Examiner: When are you going to refer the child? After Blood test or before blood test? I told, after blood tests as I can order them now straight away, if the result is positive then I’ll refer to specialist. The bell rang.

    (13) A 10 week old baby is coughing. Chest examination shows no crackes. Fever present, mildly dehydrated.
    Task: You are about to see a video.
    Take relevant history and make a diagnosis.
    Explain the condition to father.
    Management.

    When I entered the room, I had a look at the video. It shows a child was coughing, it wasn’t a typical whooping cough but the child was turning pale and quite distressed. I asked father, I know you are worried for your son, I need to ask some questions, is that ok? He said, yes sure. I asked-Birth history, jaundice, vomiting, feeding. He was wetting less nappies and getting distressed. Child is not feeding well.Immunisation up-to-date.

    Father asked: What happened to my baby? I said, most likely your child is having infectious disease called whooping cough. I explained what it is, I need to admit him to hospital because I am concerned the baby is not feeding well, wetting less nappies and he is quite young. Father: I had cough few days back, can he get from me? I said, it’s possible as baby’s immune system isn’t mature enough to handle infections. He asked: Should I be checked? I said, that would be a good idea. He enquired: What they will do in hospital? I said more tests such as: Blood test to confirm the disease. Father: Any Medicine? I said; yes antibiotic, both to baby and your family members as prophylaxis. I also need to notify infectious disease. Father: why it happened? My baby had immunization. I told, immunization don’t give 100% protection, but it’s good you immunized him, that why he is having the less severe form of the disese. A non-immune child would be more vulnerable. And the bell rang.

    Obs and Gynae:

    (14) A 27 year old lady 38 week gestation came to the hospital. Examination shows an accidental breech presentation, she is in labor, cervix is 4 cm dilated, membrane not ruptured. Her antenatal visits were not regular.

    Task: Talk to the patient, discuss the pros and cons of Breech delivery and C-section, management options. (You are not suppose to ask any examination finding from the examiner) Counseling breech presentation


    I started by asking, how are you doing now? She said she is fine. I started by asking ante-natal history- TORCH infection, any Diabetes/Hypertension, Blood group ( She didn’t know),18 week USG (single baby),any bleeding during pregnancy. Everything was fine according to her statement. It’s her second baby; the first baby was fine with normal delivery, no complications. I have to relay on that as I was not allowed to ask anything to the examiner. I asked if she is feeling regular contraction, she said yes. The patient asked, what is happening with me and my baby doctor? I drew a diagram and explained, usually in the tummy, the baby’s head comes down first. In your case the baby’s bottom is coming first. This is called breech presentation. In these situations, we can do vaginal delivery or C-section, the choice is your’s. There are different type of breech, I told her. If it is -Footling and extended breech, we can’t do normal delivery. Then patient said, I am more interested in normal delivery. I said, well we shall keep that in mind. I will call Obstetrician to see what type of breech it is and if can be delivered normally. These type of delivery has to be managed by specialists. They might need to use an instrument sometimes. And we will do CTG, and regular foetal monitoring. If the baby is not happy, any distress; they might consider doing C-Section. The patient asked whats the problem in C-Section? I said, as you know, every surgery has bit complication such as bleeding, infection, mastitis, DVT etc. She asked whats the risk of having breech delivery? I mentioned Shoulder dystocia, fracture. Then the bell rang. The examiner didn’t say a single word.




    (15) A 58 year old lady came and having complain of something coming out from the vagina. There are some rashes around the lower tummy and groin region as well.
    Task: Take History, examination finding from the examiner, explain and manage.

    I entered room; the lady was a nice one. I took history regarding any pain, bleeding, weight loss, family history, Incontinence, Child-birth, and Medication-HRT etc. She had prolonged labour with big baby and normal delivery. She has a feeling of heaviness at lower abdomen as something buldging. I asked any post-coital bleeding or pain. She said, not pain but uncomfortable feeling. No vaginal dryness, pap-smear done-normal. I asked about the rashes, when it appeared, any chemical use, itching, any discharge or pain etc. There wasn’t any problem just dry rashes. I turned to the examiner and asked for-General appearance, normal, BMI-31, Vitals normal, Urine dipstick-normal, BLS-high, Physical examination-No tenderness, no vaginal atrophy or bleeding spots, Bimanual and cervical excitation normal. In speculum examination-Uterine prolaps. I asked whats the degree of prolaps? Examiner said, not given. Also Some rashes at groin region. I asked what type of rashes, any discharge? No discharge, just dry rashes. Hernial orifice-normal. Other laboratory examination- FBC, ESR, Liver-Renal function test, Urine analysis, fasting blood glucose, Pelvic USG-All Pending. I turned to the lady and said, Mrs.X, you have a condition called prolaps.I explained due to childbirth the pelvic muscles get weak and it leads the womb come down. I said the rashes you are having may be due to Tinea. I also mensioned about losing weight and managing blood sugar. I wanted to say more but the bell rang!! I quickly said, I am going to refer you to a gynaecologist for more investigations and treatment.The role-player didn’t ask any question rather than answering my quiries.And the examiner didn’t either.

    (16) A 45 year old lady, currently on OCP, wants to know about HRT.
    Task-Take history, talk about HRT, manage

    I entered the room. I greeted the patient and started taking history- menstrual pattern, pain during periods, any P/V discharge, tummy pain, family history of cancer, History- hypertension, Diabetes? I asked her, do you feel mood swing, hot flushes, and vaginal dryness? She said, no.
    Everything was fine, she had 2 children. Paps smear normal. I asked, How long she is taking OCP.She was taking OCP for 10 years and not very happy about that. I asked if she is having any OCP side effects, breast pain, spotting, and wt gain. She said, not really but she wants to try something new. She heard about HRT from a friend and wants to try it. I asked her if she has any idea about other contraceptive method. She said, not very much. I told her about Implanon, Inject able contraception, IUCDs.I told, HRTs are an option but usually works well for ladys who started developing menopausal symptoms such as hot flushes, vaginal dryness. Because, after menopause, female hormone declines making woman prone to osteoporosis etc. Then I mentioned HRT side effects. I told, I shall provide you some reading materials and pamphlets regarding HRT and other Contraceptions. You can think about it and we can discuss it down the track. I finished just on time. Examiner was quite.


    Note:

    I tried to write down as far as I could remember. Please take feedbacks from other candidates as I might miss few issues. Also different people have different experience. I didn’t get AMC feedback yet, so don’t know which stations went wrong. At the end of the exam, it was really hard to predict whats going to happen. Most of the examiners didn’t ask any question, so it was very confusing whether I am going the right direction or not. I was very worried until the result came. Alhamdurillah I passed. Thanks to those people who made the feedbacks. My personal experience is- When patient is worried; first try to address his/her concern, reassure if you are sure it’s not anything serious. It gives the opportunity to build a good rapport with the patient. Talk to the patient with a warm approach and address their concerns, reassure where appropriate, try to be empathetic, draw diagrams to explain, maintain good eye-contact and stick to the task. I was even looking at the task inside the room while talking with the patient. Don’t go through details if not required. Follow the task and keep it simple. The thing that really helped me is pamphlets and patient education materials-which you can get from internet or GP centers. That gave me a good idea how to explain patients in layman language. The book “Patient education†and “GP book†should be enough for most of the information. Go through feedbacks-I went through 2003-2004-2005-2006-2007 cases. After exam, no one is 100% satisfied as everyone makes mistakes. Study hard and in the right way, put your highest effort, practice communication skills and physical examinations as much as possible, you will pass!! Wish everyone all the best.

    Cases:

    1) Cyclical Mastalgia
    2) Smoking counseling
    3) Auto sclerosis (Ear examination)
    4) Chest pain-Pericarditis
    5) Neck lump (Parotid swealling+Examintion)
    6) DVT
    7) Groin pain (Hip examination)
    8) Generalized malaise
    9) Risperidone side effects (Hand examination)
    10) Mania
    11) Osteomylitis
    12) Coeliac disease
    13) Whooping cough
    14) Breech presentation counseling
    15) Utero-vaginal prolaps with Tinea rash
    16) Lady on OCP wants HRT
  2. NEWEST GUEST

    NEWEST GUEST Guest

    thank you dr.autumn for your feedback.god bless you.
    however we need to know more about the books that you read in preparation for the clinicals.plz show us in detaails the names of the books and the authors so that we can purchase them,esp regarding psychiatry and obs and gynae.
    another question did u go to any bridging courses?
    were there any websites that you specifically found usefull?if yes which ones?
    plz your answer is very important to us as it will be a life saver.
  3. Dr_Autumn

    Dr_Autumn Guest

    Thanks for the best wishes.

    I went through John Murtagh's book " The GP book" Patient Education,Davidson-for reference,Clinical specialities,Melbourne Pediatric handbook,Gynae and Obs-Lilian johns,Oxford Gynae handbook.Surgery-Scott.Referance-belly and love,Psychiatry-kaplan.I looked at Internet for any confusion.For ECG and X-ray,CT I went through library books.ECG-there is a book called ECG made easy,thats a good one.I used to go Westmead hospital library for group-study and looked at books over there for reference.It should be enough to folllw the main books.But for extensive knowledge,you can look at referance books as well.I can provide some of the websites I found useful for reference.

    Good luck.

    Psychiatry:
    http://www.psychnet-uk.com/dsm_iv/dsm_iv_index.htm

    Medicine/Surgery
    http://www.merck.com/map/

    http://www.healthsystem.virginia.edu/internet/childrens-heart/pted/home.cfm

    Hepatitis
    http://www.hepatitisaustralia.com/pages/Treatment_of_Hepatitis_C.htm

    Australian journal:

    http://familydoctor.org/online/famdocen/home.html

    Australian reference website:

    http://www.drsref.com.au/ausmedsite.html
  4. Dr_Autumn

    Dr_Autumn Guest

    I did the Bridging course," Royal Australian College of GP" Sydney one.That really helped me to built up the confidence,Communication skills.The education materials and the practice MOC exam was also helpful.
  5. NEWEST GUEST

    NEWEST GUEST Guest

    THANK YOU ALOT DR AUTUMN.YOU WERE EXTREMELY HELPFULL.MAY GOD BLESS ALL YOUR LIFE,YOUR CAREER ,AND WHATEVER YOU DO.
  6. atan

    atan Guest

    Thank You

    Thank you Dr. Autumn for a valuable post and information. It is also helpful if you share your clinical exam. preparation exprence idea. God Bless you and also pray for us to overcome this battle. Best whishes
  7. ami07

    ami07 Guest

    Go through feedbacks-I went through 2003-2004-2005-2006-2007 cases.

    To autumn

    Thank you for your feedback. In this site I found only clinical questions but little feedback. I would appreciated it if you could mention where I find more feedback for clinical one.

    Thank you
  8. Dr_Autumn

    Dr_Autumn Guest

    Thanks to all for the best wishes.I hope and pray so everyone gets through the exam.

    The feedbacks I collected from Westmead Hosptal library.Thats the place where most of the the oversease doctors study.I also did group study there.If you live in Sydney,you can go to westmead hospital library,find people who are preparing for Clinicals and photocopy their feedbacks.They have a photocopy mechine in the libarary.Otherwise contact someone who is preparing for clinicals or cleared the exam.

    Good luck.
  9. Guest

    Guest Guest

    Hi....only 22 out of 72 people passed in the sydney may2007 clinical exam and all who had done the bridging course.It's a pity....
  10. Guest

    Guest Guest

    Feedback Copies

    Hi there

    I am in Melbourne, dont know anyone in sydney, is there anyone can help me to get feedback copies. can some one can drop their contact number and i can come to sydney and collect materials
    appreciate your reply
    thanks
    Nish
  11. samar78aa

    samar78aa Guest

    THATS REALLY COOL THANKS DR. AUTUMN GOOD BLESS YOU WISH U

    THE BEST OF LUCK
  12. red rose 79

    red rose 79 Guest

    Melbourne retest june 2007

    Melbourne Retest June 2007 Paper compiled by Malik

    1. A young man,who is a painter is admitted in hospital with acute asthma attack.He was admitted in ICU. It was the worst attack he ever had. He is shifted to the ward.He is on oral steroid.He wants to go home.O/E few rhonchi.PEFR is 450 ml.
    Your tasks
    1.Discuss with him severity of attack which he had
    2.Tell him which medications you are going to start him now
    3.Future management of asthma

    It was my first station.So I went inside.I asked him if he knows anything about asthma….he said not really
    So I told him whats asthma,s/s.I told him it will be a multidisciplinary approach.I will book his appointment at asthma clinic and he will be seen by asthma nurse which will educate him about use of spacer,respiratory physician will be involved.GP will be involved in care.
    I told him that he had a bad attack and its important for him to be compliant with medications from now onwards. we need to start him regular pulmicort one puff bd and ventolin puffs whenever needed.Told him about asthma action plan briefly if there are no s/s at night and morning continue as I told you …if there are s/s double dose of pulmicort and take ventolin 3 times daily regularly.I told him about warning signs ..if u r unable to speak or ventolin is not helping go to ED then.
    When I was stuck I asked do u have any concerns
    Questions asked
    I don’t like taking puffer is it imp? Yes its imp…otherwise you can have fatal attack ..asthma educator will tell u correct use of spacer
    Do I need any further investigations/? Well when you will go to asthma clinic they will do spirometry on u
    Do I need to see specialist?yes at asthma clinic u will be seen by respiratory doctor
    What are side effects of medications?They cause dryness in mouth so always gargle your mouth after pulmicort.
    At end Something struck to me he is painer so I told him well do u u know your asthma triggering factors..it can be your paints..there r different types of paints available so you need to work with those which don’t trigger your asthma..i will ask occupational therapist to see u …bell rang

    2.Young woman gave birth to baby 10 weeks ago,has 24 months old another child came to see u as she has no energy
    Tasks:
    Take relevant history
    Management

    I went inside greeted pt…congratulated her on having baby…asked her for how long have u been feeling like this…said ever since he was born I ruled out all depression s/s..low mood,disurbed sleep used to wake up in middle of night,tired,has suicidal tendency AT 4 OO am wants to harm herself by taking pills ..i asked do u have any pills ..said panadol tablets…no ideas of infanticide..no hallucinations/delusions good insight ..
    other history planned pregnancy,husband supportive..i told her you are having Postnatal Depression..i want u to go to hospital immediately in ambulance
    Do you have any concerns
    Do u think it can be anything else/? It can be problem of thyroid or low haemoglobin at hospital they will do all blood tersts
    Will medications will affect my baby? ..oh r u breastfeeding..well specialist will give u tablets in small dose and they will be safe for baby
    I don’t have anymore questions..examiner u can go out and wait.

    3.You are seeing middle aged man who smokes 15 cigrettes /day.He has some problem in throat
    Tasks
    Relevant history
    Examination findings investigations
    Manage

    I went inside greeted examiner and pt..there were 2 examiners so I knew I had to be careful in this station
    Hx. He had feeling of lump in throat. For 2 months .no h/o dysphagia to solids /liquids ,no sore throat ,no stucking of food while eating,no ulcer/heartburn..no regurgitation of food.
    No features of malignancy ,weight loss,low appetite night sweats/thyroid
    Asked about stress said not really No problems in sleeping .Had been smoker for years..i was stuck here ..there was no clue.
    Examination ; All normal no enlarged lymph nodes..
    Management I told him I am little bit concerned due to your smoking so I will refer u to specialist who will do investigations..if they are all normal them then I will send you to another specialist.
    Examiner whispered in my ear who will be another specialst I said psychiatrist for Globus Hystericus but we have to exclude organic causes first

    Examiner nodded so what will u do said..FBE,EUC,LFTS,TSH, BRONCHOSCOPY,CXR HEAD and neck…he asked what else…I don’t know what to say…I said Endoscopy he smiled which endoscopy…I said upper GI ..So u want to look into stomach as well okay what else ..bell rang
    After exam another candidate said indirect laryngoscopy…for which u have to refer to ENT
    I spoke to one of my senior colleages who has attended a lot bridging courses as well he said in if you have done BRONCHOSCOPY that’s fine…it will see larynx as well..in this case Critical error is if u send him home with Globus hystericus..He is smoker so u havre to exclude major causes .thats is definition of globus hystericus as well in the absence of organic causes


    4.You are seeing lady in ED she c/o off and on pain over few days,her bowel habits were normal but now she has constipation and had not passed flatus.Long stem

    Tasks
    Perform relevant examination
    Discuss d/d and investigations
    Management

    • I went inside greeted pt asked if she needs pain refief and she said yes I do..i said okay I will let nurse know about it.Did abdominal examination ..tally o connor one…O/E abomen was generalized tender ..percussion note tender I asked about PR Said B/L Tender with bogginess!!!Auscultation no bowel sounds
    • I told her it can be anything we need to do further tests FBE,EUC,LFTS,TSH,INR CXR erect,AXR ,pregenancy test she said I had periods 3 weeks ago
    Pt asked what it can be ; Well it can be intestinal obstruction,ischemia,gall bladder ,pancreas,appendix..it can be any hole in gut..perotonitis..DUE TO B/L TENDERNESS ON PR …said it can be abscess..she looked at examiner and said..where do you think is abscess..i said its huge tummy it can be anywhere so we have to do further tests
    What will u do now..well u cant eat and drink…pass N/G,iv lines ..IV fluids, and ask surgical reg to come and see you..
    No further questions..u can wait outside.

    5.A young man comes to GP clinic c/o tremors in hand drinks 4-5 cans of beer
    Task
    Relevant history
    Examination …investigations
    Management

    History:I asked about tremors ..said for few months…I asked about thyroid problems..nil..anxiety..no s/s ,TIA s/s any weakness in body said no Pt said whenever I hold newspaper I had them..when I drink ..i hold glass of drink tremors start and drink spill on me..any thing brings them on ..i am scared to hold glass of drink because I think they will initiate tremors and drink will spill….I Cant Understand What He wanted to convey by saying this 2 times
    Said that I am scared I wont have Parkinsonism
    No other problem besides drinking no h/o DM,HTN,High cholesterol

    Examination :power equal in all 4 limbs,no carotid bruit ,pulses equal,no rigidity
    No bradykinesia,no gait problem No tremors at rest

    Management ; I told him u r having Benign Essential tremors..you are not having Parkinsonism.Said I will refer you to general Physician he will strart you on propanalol ..do u have asthma..he said no okay.I think I mentioned u need to be careful with drinking as it increases risk factors for heart problem

    Another candidate said I mentioned alcohol withdrawal and LFTS and examiner said good .I did not mention them..plz do check

    6. female 35 yrs old has breast pain which is cyclical..her mother had breast cancer at age of 68..She is concerned about cancer.Not on OCP..NEVER HAD MAMMOGRAM
    O/E no lump palpable..b/l tendernress with lobularity
    Tasks
    Talk to pt tell her your diagnosis
    Management

    I told her you are having Cyclical Mastaslgia…it is due to hormonal imbalance.It is not cancer..regarding treatment before strart of periods wear comfortablr bra,do relaxation exerxises…have evening primose oil..i will give you mefenamic acid for pain control.
    You are 35 yrs old and u are very concerned about breast cancer so I will organize for you USG and mammogram.I will also refer u to breast screen Victoria.They will contact you regarding further investigations.
    Pt asked will I have these s/s after menopause as well…I told her it depends on stages of menopause in early stages of menopause u may still have them
    Its not cancer…no its not cancer
    Examiner said how can u be so confident that its not cancer I said that’s why i want to do USG and mammogram ….the pt will be satisfied and as GP I will be on safe side. He nodded his head and you can wait outside
    After examination another candidate said according to breast cancer guidelines u have to do both USG and mammogram

    7. 3 yrs old child had viral infection recently now came to you as GP have bruises and petechiae on body…had nose bleed the other day..otherwise playful
    Task
    Ask examiner examination findings and investigation results
    Management

    There were 2 examiners….
    Examination findings
    Alert,no problem of breathing,not cyanosed,not dehydrated,ear nose throat normal,no neck stiffness,chest cvs normal,GIT normal..bruises ..
    Investigations he gave me FBE Report on that Hb was normal,WCC normal,Plalelets low..i asked about PT APTT ,Bleeding time he said this is the only investigation available…
    talk to pt
    Told pt your child is havibg Idiopathic Thrombocytopenic Purpura.It happens after viral infection..at the moment it is serious condition but has very good outcome if u get early intervention.Said to her I need to send your child immediately to hospital.Because his platelets are low he can have bleed into head even with minor injury ..at hospital they will do blood tests..consultant will see your child..will give him steroid,immunoglobulin and if needed platelet infusion.
    Pt asked is it serious..said at the moment it is but has good outcome
    When do u want me to go..right now straightaway in the ambulance
    Pt said I don’t have anymore questions…Examiner asked wait outside

    8.A young lady comes with P/V Bleed and abdo pain.She had spontaneous abortion at 8 weeks before.She is planning preganancy
    Task
    HX
    Exam and inv
    Mx and future pregnancy advice

    At this station there were 2 examiners…incuding Dr Pepperrell …who is in AMC film as well.At that station I was bit confused didnt know why

    I asked is pt is stable ..pulse examiner said 60/min,BP 80/5O,temp not done,RR not done.I said 80/50 is criterion for code blue so I will call code blue.
    In the meanwhile I will stabilize the pt ,Foot end above,o2,IV line,draw bloods for FBE,EUC,LFTS,INR,CROSSMATCH AND Blood group.,urine pregnancy test I asked whats urine preganancy test she said its not available
    I said to examiner I will examine pt first then I will take history
    Examination findings.alert chest CVS normal,GIT some tenderness,P/V os open with Product of conception inside.I said I will remove product of conception.I asked any adenexal tenderness she said no.
    Then on hx she said I am planning pregnancy,feels tired and does not know her blood group I told her u are most likely having abortion…it can be ectopic..it can be abortion we need to do USG to find out more
    I said to examiner I will do Fetomaternal haemmorage test ..if in case she needs anti D and I will call O& G REG
    I told pt in your next pregnancy u need to have USG before 8 weeks.
    I asked about previous abortion if she had any d & c,if she received any anti D to all questions she said I don’t know.
    Pt asked why I am having abortions..i said for healthy pregnancy u need healthy baby,healthy uterus and healthy hormones..i will book your appointment at consultant clinic…they will do further tests
    Bell rang
    After exam one candidate said in this case critical error is if u dinr=t remove product of conception asit is cervical shock..secondly u have to give anti D because she has O-VE Blood…

    Its very stressful and unpredictable exam….
    Listen to pt questions and answer them wisely ..they deal with critical errors
    Do recalls and study recall topics as follows
    Medicine & Surgery common clinical cases in medicine and surgery by Peter Devitt
    O & G and paeds Guidelines of Royal women and children hospital Melbourne available online
    Psychiatry core clinical cases in PSYCHISTRY by Tom Clark
    And of course John Murtagh
  13. Guest

    Guest Guest

    hi, thanks for the tips.

    just want to ask how soon is the retest being given after your first test? thanks :)
  14. Guest

    Guest Guest

    That's really helps thank you

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