Melbourne 28th April 2007 AMC Clinical 16 questions.

Discussion in 'AMC Clinical Exam' started by Guest, May 1, 2007.

  1. Guest

    Guest Guest

    Please list Melbourne 28th April 2007 AMC Clinical 16 questions. It’s a great help for me. Many thanks….
  2. Guest

    Guest Guest

    list of april 2007 clinical

    1-PTSD the police woman who had an accident and doesnt go to work on mondays
    2-Resperidone side effect
    4-Ovarian cyst
    5-Gestational DM
    6-Hip pain in 3 year old boy with abnormal blood picture
    7-Bronchiolitis Video
    8-peanut butter allergy
    9-Hypthyroidism diagnosis
    11-heart diseas risk factors
    12-myopia eye examination
    14-Fibular fracture
    15-dysphagia or heart burn
    16-haemorroids in 23 year old man with family history of colon cancer
  3. Guest

    Guest Guest

    AMC Recall -28th April 2007 Melbourne

    1. Haemorrhoid (GP setting)
    Rectal bleeding in 25 y male, about 3 weeks. No other problem. Father rectal Ca at 49y.
    Task: Hx, PE, Ix, Mx
    Q from examiner: how to check haemorrhoid
    Q from patient: what’s high fibre diet

    2. Dysphagia (GP setting)
    50 y male with 15ys of reflux and heart burn. Increasingly difficult to swallow food. Decreased appetite, lost 3kg in weight.
    Task: Hx, PE, Ix

    3. Fibular fracture (ED setting)
    18 y boy, fell down and presented in ED with pain and swelling in his left ankle. You sent him for X-ray. X-ray has arrived and the patient is waiting for you.
    Task: Read the X-ray, explain the condition to the patient and answer patient’s questions, Mx.
    Q from patient:
    - how long do I need plaster
    - When I can recover

    4. Eye Examination / Myopia (GP setting)
    18 years old man come to you because RTA send him for eye check up, he have difficulty to see the traffic signs very well.
    Task: examine the eye and talk to the patient.
    On the visual acuity examination finding he has problem to read 6/18 then I did pin hole test to see refractive errors. Then I asked to do ophthalmoscopy to detect pathology in the lens, vitreous, and retina and rule out any serious problem. I arranged an appointment for them to see a specialist; he will give them lens or glasses (concave).

    5. Cardiovascular risk assessment (GP setting)
    A 50 y male came for check up. His brother just had coronary artery bypass
    Task: Hx ,PE, advice
    Hx of HT, no symptom, smoking for 20 ys, BMI 30, abdominal obese.

    6. Migraine (GP setting)
    A 38 year-old woman came to you with severe Headache and vomiting. She had a history of Migraine 2 months ago. The CT scan result doesn’t suggest any tumor.
    Task : Take relevant History ( not more than 2 minutes)
    Explain the condition to the patient

    7. Hypothyroidism (GP setting)
    60 y lady presents with tiredness, weight gain, intolerance to cold weather. TSH increased T3, T4 reduced
    Task: Hx, PE, Ix, Dx and DDx,

    8. Nut induced anaphylaxis (GP setting)
    A 22 y male had a history of eczema and asthma. Last night in the party after eating a walnet he started having wheezing, SOB and urticaria. He had peanut allergy at 7, 9 and 17y. your diagnosis was nut allergy.
    Task: Counselling

    9. Viral bronchiolitis (ED setting )
    Mother brought on her 4 month baby to the A & E department. Baby has cold with runny nose 2 days ago. Last night child developed dry cough, SOB and fever. (AMC video was provided) can see accessory muscle movement.
    Task: Take a focused history from the father
    Ask physical examination findings from the examiner
    Counselling and Mx

    Q from patient:
    - Can I take my child to go home?
    - How long you want to keep my child in hospital?
    - What are you going to do for my baby?
    - Oxygen, then examiner ask why? (O2 Sat 91%)
    - Are you going to give my baby antibiotics?

    10. Glandular fever/Irritable hip (ED setting )
    A 3 y boy sudden hip pain from this morning. Refused to walk. Two weeks ago had sore throat.
    Task: Hx, PE, Ix, Mx
    Hip X-ray showed: just effusion, no fracture or other bone problem.
    FBE: can see atypical lyphocytes

    11. Encopresis, constipation (GP setting)
    5 years old boy is soiling his pants for the last 6 weeks.
    Task: Relevant history and PE from the examiner
    Discuss management with the mother

    12. Gestational diabetic (GP setting)
    A 34 years old lady with 28 weeks pregnancy came for antenatal checkup she had a fasting level of blood sugar at 7.5 and prandial level was 9.5.
    Task: Hx, PE from examiner and talk to the patient about your Management plan.

    13. ovarian cyst (GP setting)
    28 y lady have overian cysts L 5mm and 20mm, R two 10mm from U/S
    Task: Hx, PE, Mx

    14. Pre-eclapsia (GP setting)
    25y primigravida attends GP at 36/40 w complains of generalized oedema and blurred vision, BP 180/120, urinalysis significant proteinuria
    Task: Hx, PE, Ix, Mx.

    15. Side effects of anti-psychotic medication/ Risperidone side effect
    Young man has schizophreniform disorder for some years and on antipsychotic medication. Stopped medication and since 3 days developed disordered thoughts, no auditory hallucinations. A GP prescribed Risperidone. He took 2 tabs in the night and 2 tabs in the morning and following which he developed dizziness: On examination BP was 140/80 lying; 110/75 standing
    Task: talk to the patient
    Assess the patient
    Hx: Have hallucination, Delusion, no suicide

    Q from examiner:
    Why is he getting dizziness?
    What should you do as a GP?

    23 yo man, diagnosed with schizophrenia 2 yrs ago, was on antipsychotics, which was stopped by Psychiatrist 6 months ago as symptoms under control. Patient developed delusion/perception symptoms recently, similar to his previous SCZ symptoms. Then his GP started him on Riseperidone, which he understood that 2 tablets every day. He took 2 tab last night, and 2 tab this morning. He c/o dizziness, esp. when standing up. Now he is in ED.
    - further Hx (no psychiatry history)
    - Relevant PE findings from examiner
    - explain to pt the diagnosis and psychiatry care and management.
    Hx: as above, nothing excited, normal oral intake, no on other meds except Riseperidone, denied homicidal, suicidal ideation, denied visual or auditory hallucination.
    PE: BP sitting 110/80, standing 90/75 something like that, significant postural drop, no signs of dehydration, other PE unremarkable.
    Explain: dizziness due to the side effect of riseperidone, we call orthotic hypotension. It is common. Could be due to you took the 2nd dose in 12 hrs from the 1st dose. Recommend take it ease when change position. Stay in ED and wait for psychiatrist review for SCZ and medications. (some candidate said pt need to be involuntary admitted as SCZ, but I thought this patient has insight, and willing to stay in ED for psy. review, I didn’t admit the pt)

    16. Post traumatic stress disorder
    A policewomen has been sent to your clinic by the department as she seems to miss the first day after every new roster.
    Task: Hx for 5min
    DDx, at least three
    On history, she witnessed an incident six month ago in which her friend was injured. On enquiry she said she has increased her alcohol intake and feels depressed
  4. Guest

    Guest Guest

    The three-year old child in item 10 appears to have transient synovitis -- usually a 3-8 year old with hip pain after a recent history of URTI. Fever is usually absent or low-grade and children are non-toxic in appearance. Usually there are effusions seen either by x-ray or US, and cultures of aspirated fluid remains sterile.

    The etiology remains obscure.
    Septic arthritis should be ruled out. Often they may be followed clinically if the child is well and ESR and WBC are normal and symptomatically managed with NSAIDS.

    Hope this helps.
  5. Guest

    Guest Guest

    about 15 ( pTSD in police woman) a question was why her condition is important in regard to her occupation?
    I responded as she probably carries gun per her duties and she may need some time off work when initiating med treatment for PTSD . also her alchohol taking habits will not help her presenting as a police.
    PLz add your comments on diagnostic procedures you may request and management of the cases presented.
    also I wonder how you may counsell the boy with peanut allergy:
    I may say: keeping epipen with himself all the time
    expecting this to occur again
  6. Guest

    Guest Guest

    no reply for the peanut allergy case
    the issue about this is that surprisingly I have failed this station, and it is interesting that before I receive the result , quite incidentally I met the examiner of this station, I didnt recognise him, though he was very interested in that whether I have passed/failed the exam. I asked him which station you were doing and how did I go in that station? He answered reluctantly that " I did not act confidently On the station"
    Later on when I received the comprehensive report of how I had done on the clinical exam, I did not find anywhere that an examiner can score the confidence of an examinee. Furthermore I had covered everything about peanut allergy and never expected that I may fail this station.Now just because I have failed this station , I got to sit for the retest exam. which does not seem fair to me.
    What I did:
    I have taken an exhaustive history of the event/ past history/hay fever/childhood asthma/atopic dermatitis/past allergy to peanut and etc/ Family history of allergy/asthma/atopic dermatitis.
    also: advised him about avoiding thing that may include peanut and check the lables in supermarket
    to refer to hospital asap with face/ resp symptoms
    to carry epipen all the time/esp when he is in bush and far away from med services/ to get one from his GP
    to let family/ freinds know about his conditon
    what went wrong?
    I don't know
    please leave your feedback about this
  7. Guest

    Guest Guest

    This pt had history of peanut allergy.
    did u ask pt about history of admitted to hosptal ED due to peanut allergy?
    how much he know about peanut allergy? has he carry epipen?
    you alredy know His PMH: eczem, asthma, so you dont need ask too many question about these.
    this episode the pt seems allergic to walnut
    you need ask pt about allergic to other nuts or food
    pt allertic to peanut may have cross reation to other nuts
    pt need to have skin prick test or RAST OR food challenge test under medical supervision
    :oops: 8) :roll: :idea: :lol: :shock: :!:
    critical error: if you dont refer pt to specialist for allergy advice
  8. samora

    samora Guest

  9. Guest

    Guest Guest

    Thanks alot

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