Station 1

Kate, 77 year old lady presents to emergency after being found collapsed on the floor of her home.

1. Please take a directed history (6 minutes)

2. Please look at her ECG and CXR (2 minutes)
Station 2

Caesar is a 64 year old gentleman who you see on the ward. Past medical history relevant for been
stabbed in the back by his friend Brutus.

1. Please perform a neurology examination of either his upper or lower limb (6 minutes)
2. Please look at his examination findings and attempt to localise the lesion and suggest a Dx
(2 minutes)

On Examination:

UPPER LIMBS

Right Left
General Inspection Laying still. Scar mid central chest posteriorly. Suprapubic
catheter present.
Inspection NAD NAD
Tone Normal all joints, no clonus Normal all joints, no clonus
Power 5/5 all joints 5/5 all joints
Reflexes Present, normal Present, normal
Coordination Normal Normal
Sensation Intact all modalities Intact all modalities

LOWER LIMBS

Right Left
General Inspection Laying still. Scar mid central chest posteriorly. Suprapubic
catheter present.
Inspection Scar from grt saph vv graft. NAD
Tone Hypertonia all joints, clonus Hypertonia all joints, clonus
present present
Power 1/5 all muscle groups 1/5 all muscle groups
Reflexes All absent. Plantars up. All absent. Plantars up.
Coordination Cannot assess due to weakness Cannot assess due to weakness
Sensation Anaesthesia all modalities Anaesthesia all modalities
through entire limb through entire limb
A sensory level was found approx at level of umbilicus.
Station 3

Steve is a 75 year old gentlemen who presents to your GP clinic regarding return to driving after a
heart attack 1 month ago. His ECG has normalised since his AMI.

1. Please counsel Steve regarding return to his work. (8 minutes)

An extract from The AusRoad guidelines for Assessing Fitness to Drive is provided below.

Station 4
Emma is a 19 year old lady who presents to emergency after episodes of prolonged vomiting and
haematemesis after an alcoholic binge.

1. What are some differential diagnosis for haematemesis? (2 minutes)

2. Please look at her investigations and interpret accordingly (6 minutes)

FBE

Hb 101 Decreased
MCV 93 Normal
Reticulocytes 4% Increased

WBC 9 Normal
Platelets 390 Normal

Film Polychromasia

UEC

Na 137 Normal
K 3.2 Decreased
Cl 77 Decreased
Ur 19 Increased
Cr 89 Normal

ABG

pH 7.51 Increased
PaCO2 66 Increased
HCO3 18 Decreased

LFT

Bilirubin 11 Normal
AST 20 Normal
ALT 21 Normal
ALP 60 Normal
GGT 211 Increased
Albumin 40 Normal
Station 5

Will is a 47 year old gentlemen who presents with a history of chronic diarrhoea.

1. Please consent him for a colonoscopy. (4 minutes)

2. Please look at his pathological findings taken from the same patient (4 minutes)
Patient Instructions:

Station 1

Patient: You have third degree heart block. Not really much symptoms; maybe previous
syncope, dizziness/presyncope. Make it up (it'll be like testing how much you know
about the condition)

Past medical history of a few AMIs, CHF, + make up others

Make up the rest.

ECG 3rd Degree Heart Block (?cause for syncope; Stokes- Adams Attacks)

CXR Pulmonary Oedema/Congestive Heart Failure

_______________________________________________________________

Station 2

Please kindly allow them to examine you :)

Examination findings, I was going for complete transection of the cord, approximately around
T9/10.
______________________________________________________________

Station 3

Patient: You want to drive around in your private vehicle. You had a NSTEMI and have been
drugged up (aspirin, beta blockers, ace, statin, others if you want).

Take an occupational history? Practice makes perfect.

_____________________________________________________________

Station 4

I was going for a Mallory Weiss.

Normocytic anaemia (although I doubt they'd be that anaemic; ?not enough blood loss).
Reticulocytosis (Incr number and polychromasia)

Prolonged vomiting causes hypochloraemic metabolic alkalosis w respiratory compensation (loss of

HCl) and loss of K+

GGT increase from alochol?

Urea:Creatinine high from upper GI bleeding (?may not happen this quickly)

_________________________________________________________
Station 5

Consent general things; introduction, procedure, benefits, risks, assess understanding, actually ask
for consent, etc.

Pathology:

Image 1:

What I suspect is the small intestine (?more pronounced folds, smaller calibre? I really can't tell).

Area of normal mucosa interrupted by areas of ulceration producing 'cobblestone appearance.

Ulcerated areas have transmural inflammation, especially seen when compared to wall thickness of
adjacent to normal mucosa. Ulcerated area seems to be narrower; ?stricture.

Impression: Crohn's Disease of small intestine as suggeseted by skip lesions, cobblestoning,

transmural inflammation and ?stricture.

Image 2

Histological H&E stain looking low powered view of cross section of what I suspect is the large
bowel (due to lack of villi, crypts, etc.).

Low power view shows diffuse basophilia? (increased blue/purpleness) of the tissue, especially
mucosal and submucosal which seems to be secondary to infiltration with numerous cells which I
suspect are lymphocytes; chronic inflammatory cells.

Not sure if there is a fissure or not.

Impression: Crohn's Disease ?of large intestine as seen through transmural inflammation
(lymphocytic invasion), particualrly of the mucosal and submucosa.