Brisbane Clinical October 2006

Discussion in 'AMC Clinical Exam' started by pandk, Oct 8, 2006.

  1. pandk

    pandk Guest

    Hi guys.
    First of all: thanks for all the volunteers who have shared their experience with all of us prior to this exam. You are great and you have done us all an invaluable service.

    Here´s my feedback from the October 7 2006 exam in Brisbane. Hope you find it useful.

    Stations in random order:

    1)
    12 yr old boy with knee pain and hip pain. Ongoing for several months, esp after playing basketball.
    Hx, PE, Mx.
    On further questioning you elucidate that the boy is a bit chubby and has had no joint problems prior. The pain is worse after basketball in is kind of dull, medium intensity.
    PE reveals mild pain on flexion of the knee as well as limited rotation and abduction of the hip joint.
    Presumptive diagnosis: SCFE. DD knee pathology and/or hip dysplasia.
    XRAY hip supplied: reveals a SCFE. Counselled pt´s father that he needs referral to ortho, likely needs internal fixation via screw to femoral head. Dad asked is it serious: yes, he needs surgical review.

    2)
    Pt with fall on outstretched hand and pain in R wrist.
    X ray shows distal radius fracture >>Colle´s fracture.
    Mx and educate patient.
    Put pt. in backslab. Need to check neurovascular status and r.v next day. Advised pt re warning signs. Change to full cast next day for 4 to 6 weeks needs f/u with ortho. Asked if need to give anesthesia prior to manipulation, i said can give iv morphine and or propofol (need consultant assistance). Also asked about prognosis re function wrist>> generally good.

    3) CT scan showing multiple liver lesions in 81 yr old man wnating to go to holiday in Greece.
    Task: counsel patient and provide diff dx.
    DDx: primary HCC versus liver mets.
    Counselling: you have cancer, either primary liver or metastasis/ spread from elsewhere. Need to do transcutaneous biopsy, ct chest abdo, bone scan. Did not get to talk about travel plans, but examiner happy.

    4) pt presenting with wheeze and RFT results
    >> looks like COPD , task: identify disease, counsel pt. re mx and cancer risk. Show how to use spacer, advised to cease smoking and use Atrovent regularly, prn Ventolin.

    5) obese chef comes to your practice with recent 5 kg weight loss and fatigue. BMI 34.
    Probability dx: T2DM. Check urine> positive for glucose. Advised HbA1C , fasting BSL, weight loss, check 24 hr urine for proteinuria, check renal function and start metformin if ok.

    6)
    Pt. comes in with uss confirming testicular tumor.
    Counsel pt. re tumor and advise mx. Needs AFP HCG to r/o teratoma, needs chest, abdo CT to check for mets, i advised bone scan also, but may not be neccessary. Asked if he can have kids_ yes, needs only one testicle removed, in general prognosis excellent nowadays.

    7) case of pt with trouble seeing cars approaching at intersections.
    Probability dx: bitemporal hemianopia DD glaucoma.
    Task: perform eye exam and discuss findings.
    On examination: normal acuity, bitemporal hemianopia on visual confrontation test. Ddx: chiasmal tumor, for instance # pituitary tumour
    # craniopharyngioma
    # suprasellar meningioma. Asked about associated symptoms related to hormone aberrations etc.


    8)
    Case of woman presenting during 20th week of pregnancy, her other child has got truncal rash for last couple of days.
    Counsel. On further questioning mother states that reash is vesicular>> likely VZV infection. Usually causes problems in first 20 weeks only. I advised to give IgG to mother, but probably not necessary. Check antibody status in mother and give IgG to child if perinatal infection occurs. No active vaccination during pregnancy. If severe chicken pox, may treat mother with acyclovir despite risks.

    next 8 cases soon

    contd







    Posted: Sun Oct 08, 2006 1:17 pm Post subject: Brisbane Clinical October 2006 part II

    --------------------------------------------------------------------------------

    9) 15 month old boy with offensive smelling diarrhoea
    Hx of normal development until now. Recently introduced solids, child is pale and has dropped in growth. Stool MCS negative for organisms. Probability dx: celiac disease. Needs TTG-a test in biopsy, obstain from gluten containing foodstuffs.

    10) case of patient with alcohol problem
    clearly depressed clinically, also problems at work, suicidal. Needs hospital admission and treatment with SSRI etc.

    11) pt presents with bilateral swelling of both lower legs. worse at the end of the day. Also on questioning admits to SOBOE. Probability diagnosis: CCF. D/w examiner re PE: would check for crackles and raised JVP etc.

    12) Pt presents with prolapse around the vaginal introitus. Pt is postmenopausal , 53 years. Also rash in both groins. Obese.
    Plan: Examine>> uterine prolapse and tinea rash. Cause: likely diabetes and multiple childbirths. Request urine for glycosuria, refer to Gyn for ureteropexy or hysterectomy (no childwish and postmenopause).

    13) Pt. in 20s found comatose in bed by flatmate. Unclear cause.
    Task: perform neuro exam. I did GCS:was 9. Then checke reflexes (nl), pupils (nl), corneal reflex and for trauma, also check breath for foetor uremicus, hepaticus, acetone foetor of DM. NEck stiffness present. Probability dx: SAH DD Meningitis. Plan: LP, FBC, BC, antibiotics, CT head.

    14) Mother presents with 3 year old daughter
    Daughter is acting differently than her peers in preschool, parent and carers worried, child appears shy and withdrawn, poor verbalisation. Otherwise normal on examination. All vaccinations done. Probability dx: Autism. Plan: advise mother of condition> refer to pediatrician.

    15)
    Pt just delivered baby in hospital, you are just suturing episiotomy when she starts fitting. BP up to 140/90, later up to 160. Baby delivered. Task: counsel upset husband, give diagnosis, educate about prognosis. Told pt it is ecclampsia with usually good prognosis cause child has been delivered. Pt asked whether we could have avoided this. I sais no, because pt. was never hypertensive until this day. Also had to give antihypertensives (methyldopa) and diazepam.

    16) pt with schizophrenia
    Requested change of medication from Chlorpromazine to atypicals since she developed long qt syndrome.
    Advised to take atypicals like Olanzapine.
    Was asked about how to actually do the change over of the meds. Said i would read up about it. Also advised to check bloods prior and after initiating tx to r/o agranuloytosis.


    All the best pandk

    16)
  2. Guest

    Guest Guest

    ARE U NOT GOING TO WAIT TILL THE RESULTS TO SEE IF U HAVE PASSED ! U SEEM TO BE QUITE CONFIDANT !
  3. pandk

    pandk Guest

    yes, why not. i know what the cases were like, does not mean i passed.

    regards.
  4. Guest

    Guest Guest

    Thanks very much for posting your scenarios Pandk, it is so helpful.
    All the best
  5. Guest

    Guest Guest

    hi there,
    i hope u pass ! :D
  6. AABHI

    AABHI Guest

    wish u all the best for ur amc clinicals result ,cm, ur posting speaks that u will definitely clear amc clinicals , pl.share joy with us.AABHI
  7. Rani Arora

    Rani Arora Guest

    what is your result, let us know.
  8. pandk

    pandk Guest

    re amc exam

    :D Thanks guys,
    i definitely passed, checked it online today.
    Will let you know what the score was and accordingly revise any cases posted.

    Cheers,
    pandk
  9. Guest

    Guest Guest

    Thank you all
  10. guest234

    guest234 Guest

    I am looking for study partner in Brisbane,any one interested e-mail me on:
    bjabir@yahoo.co.uk

    all the best

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