MAR AMC Clinical Exams Melbourne 10/02/07 |. HSP ‘You are 2 RMO in hospital paediatric ward, a 7 yo boy was admiited. He had URTI 10 days ago, then he developed rashes in the buttock and lower limbs, ‘with painful and swelling ankle, abdominal pain. Task: . © explain to parents the diagnosis. © explain the management and answer parents’ concems. Parent's questions: Is it leukaemia? Is it meningitis as there are rashes? what about follow up? What about prognosis? Whooping cough 10 weeks old infant, full term and normal vaginal delivery, was well until 5 days ago he had runny nose, then paroxysmal cough, with cyanosis at the end of cough, in between he was OK. Mum brought him in ED. PE: GA and VS normal. No crackles or wheezing. Task: © video available to see the cough pattern © further Hx ©. Diagnosis and management. No PE required. ‘Hex: the patient was well until few days ago developed runny nose and cough, no fever/mild temp?, no rash, no nausea or vomiting, slightly decreased oral intake, nappy still wet as before. Husband is a heavy smoker, smoke in house, had chronic dry cough for few weeks already. Another 4 yo boy at home, but hhe was well. Dx: Whooping cough Mr: (Pease chéck Puedistric handbook) Explain to parent what is Whooping cough. Natural course of whooping cough. © need to be admitted to hospital for oxygen as low oxygen for <6 mon baby will cause brain damage. © 7 days clarithromycin © 7 days clarithromycin for houschold contacts. Child abuse 19 yo mum brought her daughter, 6 months old to GP. Her daughter,was a preterm baby, unplanned preg., normal vaginal delivery. Mum working part- ime. Current partner, no the daughter's father, unemployed, takes care of the baby when mum is working, ‘The baby was orying all the time for 1-2days, mum concerned and brought her to see you, her GP. You performed PE and there was a bruise on L cheek and upper lip, bruise and swollen of R arm, X cay confirmed spiral # of R humerus. Task: © Further Hx © Explain the diagnosis to mum and management. No PR required.‘Hx: Teenager mum, unplanned preg,, part-time office worker, denied postnatal depression symp, stated that she loved her daughter and had good bonding, with daughter, non-smoker, occasional drinker, no illicit drug user. Curent partner: no daughter’s father, unemployed, smoker, drinker and ? . drug user, ‘Mum trusts partner, stated that he took care of baby very well. The baby fell over from change table 2 days ago, then cried and unsettled all the time. Texplained to mum that there is a fracture of arm. Mum felt relief as there is a reason for baby’s crying, I referred the baby to ED and told mum the baby riged to be admitted for further management. I was hesitated to mention Child Protection Service to mum, then I turned to the examiner and said I would refer the baby to ED but I would like to contact Child Protection service for suspected child abuse, But examiner dismissed me and asked me to talk to mum. So I had to tell the mum I would contact CPS and there will be social worker involved when the baby is in ED, because the fractured arm is unusual for young baby, we need further investigation. Unsurprisingly, Mum jumped and yelled that are u going to.take my baby away from me, we didn’t do anything wrong for my baby, we love baby. [had to use communication technique tried to minimise the angry reaction and comfort the mum: we just want to make sure the event would not happen again for you baby, sometimes teenage parent found difficulty to manage baby, especially premature baby. Mum: do you think teenager parents can not take care baby, we don’t need any counselling, we don’t need parenting skill education.... Then bell rang. pelvic mass 23 yo lady, see GP for regular Pap Smear, her previous Pap Smear were normal. When you perform PE, a 2m mass from pelvic was felt. Task: © explain the DD and management to patient, . History: healthy lady, regular'period, 3-4 days/28 days cycle, no dysmenorrhea or menorthea, last period 3 weeks ago which was her normal period. Regular partner, use condom for contraception. No abdo pain, abnormal PV bleeding or discharge, fever, wt loss, nausea, vomiting, diarthoea or constipation, appetite change, urinary frequency or buming. Sensation. PE: GA, VS, resp, CVS: NAD. No lymphoadenopathy. Abdo exam: only a mass 2om from suprapubic, no tender, otherwise normal. VE: no bleeding, discharge, cervical changes. Only a mass felt, 2cm suprapubic,non-tender, can’t tell from uterus or adnex. (examiner was no very keen to provide any PE finding and only em phased on what he thought is important) DDx: pregniancy-urine preg. Test Fibroid, ovarian cyst-need pelvic U/S Patient ask: can I have baby in the future?5. home delivery : A 12 wk pregnant lady asked about home delivery. She was healthy before, the first antenatal. visit was normal. Now she is attending 2" antenatal visit. Task: © farther history © answer patient's questions, no PE required. J think this topic was well covered in the book “Examination obstetrics and gynaecology/ Judith Goh, Michael Flynn. 2™ ed. Sydney: Saunders, 2004.” © Pv dlecaing 43 yo lady, husband died 2 years ago, had 4 children (from 10-20y0). C/O PV bleeding unrelated to her period. “Task: © farther Hx © PE from examiner © Dx and management. ») Hix: Regular period, 28 days cyele, last period 3 weeks ago, which was normal period. But she had PV bleeding 10 days ago, amount as period. She never had this kind of bleeding before. She admitted having sex with a man 10 days ago, using condom, which was first sexual life after the death of her husband, then * bleeding Started after the intercourse. No abdominal pain; no wt change, no diarthoea or constipation, no nausea or vomiting, no dizziness, no pain any _sihere, no UTI symptoms, no vaginal discharge apart from the bleeding, no fever. Last pap smear 14 yrs ago. No significant FHx, Was on OCP, but stopped since husband died. PE: GA, VS, Lymph nodes, Resp, CVS, Abdo examination : NAD ‘VE: big cervical lesion, extended to posterior of vaginal wall, contact bleeding. Otherwise normal. DDx: STD Cervical Ca, Mix: 1. high vaginal swab, intracervical swab for Chlamydia and gonorrhoea, other STD. 2. Pap smear/ cervical lesion biopsy pow as a 3. Pelvic U/S " ‘ w : eer 7. Mumps orchitis Lfaramy20 vies) 2 Tiwi intake & GP setting, you diagnosed the 43 yo man with Mumps 5 days ago as he 4 blond dt —_ presented with painful parotid, fever, lethargy. His 6 yo son had Mumps 2 B-upperine undererel weeks ago and was in recovery, You asked patient to have rest and» A. Seaside -7° fo paracetamol, Patient presented today us increasing T, painful E testicle, Soere pain au M0 Task: ~ teats m ag % goer puber egperd fo + BAX OF @ explain to patient the diagnosis ~ bbbeayen edeity Keorautor nan answer pt’s questions. No PE required, ip fern tesies are ~exttuse, peom sucol Questions: ae ft vem. What isthe diagnosis? . .,, Any complications from Mumps and mump orchitis: meningitis, atrophiy of = de any other ¥25 testicle, infertility? at none 3 Noumaln | Any impact on sexual life and fertility? " ate miy tL 4-S¥”" Testicle pain no be controlled by Panadol, what can u give me for the pain? “Dok & EPR. ge