Discussion in 'AMC Clinical Exam' started by Reza, Jul 30, 2006.
please if anybody knows the yesterdays stations in goldcoast post them.
One of the cases:
Ross River Fever :shock: :shock: :shock:
some of the cases were as follows :
a case of swelling upper arm - d.v.t
a case of foreign body ingestion - metallic pin in a child
a csae of herpes
a case of ?endometriosis
waitting for the rest feedback , cheers ,yusari from egypt.
Pleseeeee somebody tell us about the cases.
Are you saying that one of the station was a Ross River Fever ?
Any feedback about the exam. I am guessing it was difficult one because not many candidate passed ( accordingly to the AMC web site ).
It's been a young man coming back from camping with arthralgia and a blanching rash.
They claim that the most probable diagnosis is Ros River fever according to the place of his camping.
A couple with infertility for a year. Husband is working away and visits her once a week. all the test results are normal.
manage the case
I was surprised that Ross Fever is actually very common disease in tropical Australia.
Ross River is virus disease occurs widely in Australia. In northern and central Queensland cases of Ross River virus occur throughout the year,
but most cases occur in February through to May. In other areas,
disease activity tends to occur in seasonal outbreaks. This reflects increased mosquito breeding during periods of high rainfall or high tides. In Queensland there are an average of 2,672 cases reported each
year, but there are many more cases unreported.
Stations of GC July exam.
1) Dysmenorrhoea : present since 5 years in a 25 year female, increasing in the past 1-2 years. Pain only with period, no increased / irregular bleeding. Uterus retroverted and mobile, no adnexal tenderness.
I just asked her to take indomethacin and return in a month / 2 if no improvement.
Some other people asked her and got a positive history of deep dyspareunia, but then they asked for a USG which was normal.
I would think that the AMC diagnosis would be dysmenorrhea, but would update once I get my results.
Others differential diagnosed Emdometriosis to be the first diagnosis. Maybe ? As I remember her asking me that if I get pregnant will my dysmenorrhea get better.
Will let you know if I passed this station once I get my written result
Will post next station mane.
Thank you carvedilol,
We are waiting for more cases
Pain relief during labour
amc part two melbourne august 2006
Hi here are the Melbourne august questions
1. A CT Scan with liver was given (Picture from AMC Anthology Book)...
It was an old lady a long history was given. Nothing pointed to malignancy in any system...
In the previous consultation u had ordered for the ct abdomen...
Now the task is to explain the ct findings to the patient and manage the case...
This was like breaking the bad news station ...started directly explain the ct which had secondary in the liver...explained that it is necessary to refer her to an oncologist. and he will do further investigations to find out the primary... tests including biopsy, and then tests like colonoscopy ...passing a tube via the back passage to see if the primary is there ...
Console the patientâ€¦give time to cry... ask if she needs any help in going back...explain what the further managent will be like chemotherapy & radiotherapy. Reassure...
2. A 27 yr old lady with previous LSCS now 7 weeks pregnant has come to u now to know if she can deliver the baby vaginally â€¦the indication for previous LSCS was fetal distress...
Task talk to the patient...
Asked her what brought her to the surgery todayâ€¦she says she wanted to know if she can deliver vaginallyâ€¦
I said she needed to answer a few questions for that â€¦
Asked what the indication was previously... she said during the delivery the babys heart beat went up suddenly â€¦she was then told that the baby was under distress so taken to theatre for surgeryâ€¦
Then I asked if this pregnancy was planned...she said yes...
Asked all routine questions...no history of DM/ HT/ Rh+ve...
Had good social support...no smoking, drugs or alcoholâ€¦ she had started taking folate 3 months before the pregnancyâ€¦
Physical examination findings from the examinerâ€¦every thing was normal...
Asked him about CPD... He said pelvis was clinically adequateâ€¦
So I said she can have a vaginal delivery... but she needed to attend the high risk clinicâ€¦need to have regular antenatal check ups...importance of good diet, exercise,not to gain too much of weight. Explained about eclampsiaâ€¦then we can have the vaginal delivery â€¦which will be monitored...
She asked if she can have induction of labour... I said induction is not allowed â€¦it increases the risk of uterine rupture...
3. A 37 yr old man (lawyer) met with a RTA 3 months ago... had a fracture femurâ€¦
After some time he developed some rashes on the extensor aspect of hands elbowsâ€¦
He was prescribed a cream the chemical constituents were described â€¦it had coal tar...
It seemed to have settled... but after some time the lesions started again...the description of the lesions were typical of psoriasis..( white scaly lesionâ€¦etc).task. 1. talk to the patient , explain 2. manage him
the diagnosis of psoriasis was very obvious.. but I knew very little about him..
so I said from the details in your case sheet it looks like you have a condition called psoriasis.. which is a chronic skin condition ..this happens because the rate of cell growth is faster and usually the new cells are bound to the skin by a substance called keratin ..but the rate of keratin does not match the cell growth.. so these are scaling offâ€¦
I said this is a chronic condition ..that means it will not go away ..so he has to learn about containing the manifestationsâ€¦this in not contagious as well..
He asked if it is cancer I said no it is notâ€¦
I said some factors like stress and sunlight may aggravate( actually sunlight is beneficial)
Because I dint know any thing else I said he can collect the pamplet which has details about doâ€™s and donâ€™tâ€™s of psoriasis and he can go through that and if he had any doubts can ask me..i also made a note about the support groups..i just mentioned the treatment will be some creams ( I dint know much ) containing coal tar ( steroids also)..we can say about the benefits of UV light
4. A psychiatry case.. a old lady retired â€¦you seen her previously.. some six months ago she came with the complaint of some skin lesions â€¦it was diagnosed as contact dermatitisâ€¦and treated. Now has come with a request for a letter from u to the housing boardâ€¦ for change of the place..
task. Do mental state examination for six minutes at the end of that summarise your findings to the examiner and give him your differential diagnosis..
the patient was well dressed.. cognitive functions normal ..good eye to eye contact..speech was normal..
she said she suspects her neighbors were conspiring against her..she over heard them talking about her â€¦she also says the next house is empty and in the place she hears those noise ..she also said she heard them telling some numbers which happened to be bank account number and she believes her ex husband is behind all this..
inbetween she insists I give the letter fast as she has to go and do the cleaning â€¦when I asked why she says every time she cleans she sees the dirty patch re appearing on the wall and is sure it is the work of her neighbours.
I asked if she saw any thing abnormal..she said while she was seeing tv she saw a programme relayed in which people discussed about destroying her..
When asked about how long this was happening she said over six months..
She is not depressed.. no suicidal tendencies..no drugs alcohol or smoking,. No underlying medical problem..
I summarized these findings and gave the D.D 1. Schizophrenia 2.OCD..
He asked me if I needed to add any thing to this as I had 68 seconds left..
I could not find any thing to tell
5. In a GP setting â€¦a father of a three month old exclusively breast fed baby has come because the baby has had diarrhea and vomiting for the past 12 hrs..
task..talk to the father..history from the fatherâ€¦examination findings from the examiner ..manage..
well as the baby was three months old and exclusively breast fed ..i was not sure how to manage..
he gave a history that the diarrhea was since 12 hrs 6 episodes and mild vomiting..3 times
all other history was normal..no contacts..wet nappies a bit less he said
examination findings from the examiner gave features of mild dehydrationâ€¦
I said diarrhea is due to virus mostly ..any way will do stool and urine tests,â€¦
Advised to continue breast feeding.. .
Explained the risk of baby getting dehydrated easily..so it is important to give the baby fluids every ten to fifteen minutesâ€¦sips of fluids( 5-10 ml).
He asked which fluid is best ..i said ORS.. if the baby does not drink it then give diluted fruit juices..i kept on saying fluids and hydration are the most important things here..so I drew the picyure of skull and fontanelle and if that becomes flat or sunken or the tongue is dry or skin losses it turgor or the baby is not feeding well to come back and get admitted
The better answer here would be to try oral fluids if the baby is tolerating send home orelse admit ..
Melbourne hand book says if baby is less than 6 months and has >8 episodes of diarrhea/ >4 episodes of vomiting then admit
6. same case as in Sydney march 2006â€¦ a case of ump in neck. Excision biopsy done..it was hodgkins lymphoma..referral to oncologist was done he found that it was localized ..advised the patient for chemo and radiotherapy..
now talk to the patient ..
just explained lymph nodes are scavenger cells in the body..they are channels connected to each other ..they filter various regionsâ€¦and the uncontrolled growth now is called te malignancyâ€¦no definite etiology known..
he lucky that it is just localized and the involved node is removed..if that is followed by radio and chemo therapy then it will be possible for him to achieve remission..
he asked if the malignancy is just localized y is it necessary for him to have radiotherapy..
I explained as these channels are interconnected micro seedings of malignant cells may be preset in other parts of the body which have not started to grow now but may turn malignant later so it is important to destroy them right now..
Explained about radio and chemotherapy and their side effects..how to manage that..
Family discussion, support groups, pamplets, regular follow up after treatment.. and also that he can go to work as usual..
7. A mother of a 4 month old baby exclusive breast feeding.. now baby has a temp of 38deg and has some loud breathing.. task..take further history from mother.. examination findings from he examiner..
Short duration of feverâ€¦all other things normal.( immunization, medical , Family H)
Physical findings showed RR:20,Pulse :140,mild use of accessory muscles of respiration..forgot to ask about oxygen saturation..RS: wheeze, crackles..
I said I needed some basic investigations.. examiner asked what all as I said bds , urine and chest xray h, he said x ray shows hyperinflation on both sides..
Then I explained bronchiolitis to mother drew picture..
Explained the management is symptomatic..
Fluidsâ€¦observationâ€¦etc..she repeatedly said she is concerned / worried that her baby is not feding wellâ€¦this was in emergency setting so I said I will keep the baby under observation for some time and see how things progress and then she can go home once she becomes confident of managing her child..
8. A case of pethidine addictionâ€¦ a young lady came to ed with complaint of abdominal pain..the registrar saw found nothing abnormal.. but as the patient said she was in deep pain he admitted because he thought in case he missed something ..
she was given two panadols ..now she is shouting that she has not been treated properly..
taskâ€¦take a short history pertaining to her abdominal pain.. and pethidine prescription..2. talk and explain to her about her addiction..3.manage her
when tried to ask about her about her abdominal pain .. the previous investigations and diagnosis .. when and who gave the injection she was reluctant to answer she said she knew that pethidine would give reliefâ€¦
her social history pointed that she was a single mother , living with her parents had a daughter..not working drank, smoked and did drugs..
then I explained that she had nothing wrong which needed pethidineâ€¦said I can understand the stress in her life.. and she is now addicted to it with her knowledge and I will help to get over itâ€¦
I reassured that I will give some other drug called nsaid s which are more efficient than pethidine and are not habbit forming
Said she will be referred to agencies that will help her with this..support group etc..she agreed
9. A case of carpel tunnel syndrome.. the scenario said a 42 yr old school teacher has come with some abnormal sensations in hand and arm..
take a relevant history.. do physical examinationâ€¦dicuss the diagnosis and management
as I asked what is wrong he said pin and needled like pain in palm..( typical carpel tunnel feature)
physical exam â€¦as in previous recalls
10. A case of neurological examination of lower limb in a patient with poorly controlled type 2 diabetesâ€¦advise further investigations and management..
just remember in all PE cases to say
1. that you have washed your hands just now..and at the end also to say I would like to wash my hands
2. to get consent from the patient for doing the examination.
3. say that ur hand might be cold so it may be little bit uncomfortable.
4. to tell u at any point of the exam if it hurts so that u will stop doing that part..
11. Photographs of a patient with bells palsy was outside..
the task was 1. first describe the photographs to the examiner.
2. explain the condition to the patient 3. manage
there were four photos â€“ one with bells phenomenon, devition of mouth, inability to contain air inside the mouth , loss of forhead wrinkling
a different person was sitting ..explained what it is ..said about facial nerve..etiology unkown.. affecting all the muscles in face..
advised about covering the eyes.. artificial tears, massage and exercises , physiotherapy..
starting steroids and electrical stimulation of the muscles..
he kept asking is it stroke? Explained difference between UMN and LMN lesion..difference..
he said he is working in a bank and didnâ€™t want to go to work.. I suggested he can use glasses to cover his eye.. then if he felt very delicate then he can have a few days offâ€¦
12. A old case â€“ Post op fluid management ..the patient had a perforated peptic ulcer for which laprotomy was done. Now post op day one.. the chart says he is prescribed 500ml of fluid over 24 hrs.. he has lost 600ml of fluid by nasogastric tube etc..
now he has anuria..
task.. examine the patient.. summary to examiner.. write a new fluid prescription to the patient
a person was lying with a plaster..
checked if there is any tenderness/ guarding / leakage from site / soiling of dressing/bladder was not palpable..
summarized .. he asked what is the cause for anuria..i said in adequate fluids..
he said write down the priscriptionâ€¦the chart had lot of squaresâ€¦
at the end there were 4 horizontal lines.. he pointed out where to write..
3 litres( 1 litre NS+2 l 5% dextrose) of fluid over 24 hrs+ 600 ml lostâ€¦( NS)
what will indicate that he is adequately hydrated â€“ urine output 30-50ml/hr
13. A lady delivered two days ago.. had difficult labour .. forceps used had tears.. sutured ..2 days post partum take history .. investigations management..
just discuss the three possibilities â€“ mastitis, UTI, vaginal infection..
14. A obese patient.. with history of irregular periods 2-3 / year..
take history, physical examinations and investigations from examiner, diagnose and manage
a case of pcodâ€¦.
Life style modification, weight reduction, ocp ( progestin), ovulation induction..
As I asked the BMI examiner smiled and said 41..so more of onesity management (surgery , Drugs)
Risk of endometrial cancer ..
15. A four month old breast fed baby.. you saw him previously.. heard a systolic murmur..referred to a cardiologistâ€¦ he did echo found it to be a moderate sized VSD..acyonotic.. now father has come to u asking about it
explained what VSD is drawing heart..as the baby is young explained that chances of closure are great ,â€¦so we can wait..explained about cyanosis.. the baby might have feeding difficultyâ€¦importance to treat any small infection as it could lead to infective endocarditisâ€¦need to have regular follow up.. no need for immediate surgery
16. Patient is a nurse.. had sore throat 10 days ago..now has come with doubts that he might have hepatitis..
task..1.take history2.examinations and investigations3. management
asked the patient y he thought he could have hepatitis .. he said he had high coloured urine..itching ..rahes..
he had no history positive for infectious hepatitis..
I said I needed to do some investigationsâ€¦
Urine,stools , blood- bile salts ,pigments , bilirubin
Serum- infectious hepatitis screen, usg abdomen to rule out gall stones and obstructive jaundice
The examiner asked what else u will do..( I remembered infectious mononucleosis but forgot what virus caused it ) so I kept quiet..
Then he asked me to explain the condition th the patient.. so I said it could be infectious hepatitis/ obstructiveâ€¦ or with H/O of sore throat and jaundice..may be infectious mononucleosis..and for the time being it willl be like management of viral hepatitis..low fat diet, rest adequate fluidsâ€¦
Actually at the end of the exam I was all confused and scared but in the rest stations I never thought about the previous stations just took rest..i really helped..in the stations you donâ€™t know much just try to be cool ..say the things which u know for sure.. or give a broad picture,â€¦donâ€™t forget pamplets., referral, support groups.and to say feel free to call me any time ..
Be confident and proceeed..talk loud and have good eye contact with the patient and examiner..
I am sure you will do wellâ€¦good look
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