Young female had palpitation and chest pain had her ECG and all test done everything

came normal. On history she is smoking and her sleep has impared due too too much work load, has recently started new business. ( AMC feed back, generalized anxiety ). Task take history, explain to the patient what is it and why it is happening and manege the case . (wanted to hear epinephrine and norepinephrine effect. 2: Permanent sterilization : Youg female taking OCP and doesnt not want to take any longer wants to dicuss with you the permanent sterilization method. Task: Discuss the method Advantages and disvantages Questions: does it affect on my menstruation, weight and sexual performance and failure rate. 3: ADHD : same as AMC handbook 4: Fever : young female has been getting fever since 3 months probably associated sweats. Task: take the history , ask examination findings from examination and order the investigation It was a differential diagnosis and organizes investigation accordingly. On history she had a travel history scratches on the body and splenomegaly 5: Ca colon : Barium Xray explain the Xray findings to the patient , he had diverticulosis and had been constipated on and off .Answer the questions asked by patient and Examiner: I t was bit hard and tricky I was going to say diverticulosis but patient dragged me on the right side asking could it be cancer, what investigation to confirm and examiner asked that how you will know if it has spreaded. 6: Headache : father is concerned about his 5 year old son who is getting headaches. Task take history, ask examination findings from examiner , diagnosis and manage the case. Father asked are you sure it is not tumour. Headache was related to school situation. 7: Iron deficiency anaemia : Father has been concerned about his 2 year old son. Discuss the

blood results with the father. Take the relevant history and management. I was given the growth chart plot the chart and tell to the father if his growth is ok. 8: Arm swelling : young boy was playing tennis notice sudden swelling in her arm : Task ask the relevant history , diagnosis and what investigations you will do? On examination no redness and tenderness just painful and pitting oedema I said thrombosis Examiner questions: Where do you think the clot is? When you send the patient to emergency then what you will write down in your notes ? 9: Large for dates : fundus height larger than the dates : Task ask the relevant history examination finding from the examiner and management. 10: Sciatica : same as AMC hand book

Task: take history ask examination findings from examiner, explain to the patient what it is and management. Question asked by examiner which nerve root is affected (single nerve root not the not the whole segment of sciatic nerve. Examiner continuously asked which nerve root I want to know the single nerve. 11: Travel advise: young boy is going to Bali in couple of days who needs your advise what he should do before he flies . 12:Abruptio placenta (concealed bleeding) : 30 weeks (probably) pregnant lady came in the emergency dept complaining for the severe pain in her tummy. Task take the history, ask the examination findings from the examiner, explain to the patient what it is and how you are going to manage. 13: Examine the hands : make your diagnosis I was asked to examine the hand and rt hand was acutely infected and tender. I was confused as everything was normal on the left side finding were positive only on rt side

therefore I though I should touch the Rt hand. But do not forget to mention and act on that (when it hurts please let me know I will cease the examination must remember). 14: Chest pain : Middle aged man came to the emergency dept complaining of pain in the chest. Task take the history: Ask the findings from the examiner,what investigations you will do : In the history he had all the risk factor, drinking alcohol, smoking taking meds for diabetes and he was obese aswell. 15: Benzodiazepine overdose : Take the history asses the mental status. The girl did not have any positive history except she has been taking marijuana with friends. Otherwise no depression, no suicidal idea . she was very hard patient she was not happy when I told her to stay in the hospital she said I want to go back and I just took the tablets to get good sleep and I am not that mad to kill myself. Hard one. 16: Terminally ill patient explain the palliative care: The daughter is concerned about her father who has pancreatic cancer wants to know about palliative care, no one lives with her father how can we assist her father in order to provide him a quality of life until he is alive. She wants to know each and everything before she goes away as she lives in other city. Examiner : patient cant eat anything what you will do ? February 2009 Recall Different version 1. inferior MI in a 60 year old man with significant risk factors. Take History and discuss management 2. Pale 9 month old came for review of blood tests. Resuilts show iron deficiency. Take a history and discuss diagnosis and management. Child still on cows milk and no solids. 3. 26 year old with lower back pain sudden onset whilst at work. Take history and request examination findings and discuss management. Sciatica 4. 33 year old female with 2 children wants sterilisation, discuss and answer her questions. 5. Travel advice to a young jounalist travelling to asia 6.Examination of hand in apatient with osteoarthritis 7. 70 year old came for resuilts of barium enema. Discuss the resuilt and management plan. Report states narrowing in descending colon.

8. 17 year old brought in after a drug overdose now stable, do a mental status examination and discuss your management plan 9. 23 year old Primigravida presents with sudden onset lower abdominal pain at 38 weeks. Take a history and discuss management. Placenta abruption, unstable and no fetal heart. 10. 34 year old female who presents with recurrent fevers for the past three months. Take a history, request examination findings and discuss mangement.-Lymphoma 11. Father enquires about 6 year old daughter with recuurent headaches.-Tension type and bullying at school. 12. Mother with 6 year old child desruptive at school. Take history and discuss management. ADHD 13. 24 year old clerk with swollen arm. Take History and request examination findings and discuss management plan. Every thing negative in history. 14. 23 year old primigravida large for dates at 32 weeks . Take a history and request examination findings and discuss management. Large for dates but normal afi 15.daughter of 70 year old with advanced pancreatic ca wants to know about condition and management- patient has given consent for disclosure. 16. A woman with Generalised anxiety disorder, smokes 15/ day and drinks a lot of cough. Discuss management

March 2009, Adelaide case 1 : a 6 months old child recently came from overseas trip has low haemoglobin and 6 weeks history of diarrhoea. take history , ask for examination findings and counsel mother. buddies whenever dealing with a paediatric case always remember three things to ask : immunization, growth chart and diet history. the child had anemia with falling off the weight for age.

fully immunized. very fussy in eating. diarrhoea started 6 weeks ago and is continuing. stools semiformed in nature with no blood. stools not bulky. no history of any recurrent infection, genetic disorder in the family. examination findings : pallor ++, no organomegaly, protuberant abdomen with muscle wasting. no findings in urine. choice of investigation: CBE, sweat chloride test, Hb electrophoresis to rule out thal., stool microscopy and culture to rule out any parasitic infection. Differential diagnosis: 1. dietary anemia secondary to poor oral iron intake. 2. protein energy malnutrition( unlikely) 3. parasitic infestation (recent oversease trip to tropics). 4. cystic fibrosis 5 malabsorption syndrome ( unlikely as it doesnt give anemia). case 2 : examination of a swelling on the face , just anterior to right ear , dermoid. case 3 : 23 year old girl with RIF pain, beta HCG positive, simple cyst 5.5cm on right ovary. case 4 : postnatal depression (typical from AMC book). case 5 : 6 weeks old child with 1 day history of diarrhoea, counsel father. case 6 : 24 year old female, LMP 20 weeks back, uterine size 30cm, was on overseas trip, no investigations done. counsel and manage. case 7 : coeliac disease. case 8 : bitemporal hemianopia, eye examination. case 9 : anorexia nervosa case 10 : 59 year old man with prostatism , undergoing TURP, counsel. case11 : 6 year old child with limping , perthe's disease vs transient synovitis of hip. case12 : pneumothorax (typical from AMC book). case13 : 60 year old lady with lethargy, history and examination findings, investigate ( wait till monday as this one was tricky and it was not hypothyroidism). case14 : 60 year old recently diagnosed with rheumatic arthritis , violin player, counsel. case 15 : 22year man, fell off from motor bike, 15 mins unconcious, perform primary survery and counsel the patient and organize relevant investigation.

case 16 : 62 year old lady, profuse vaginal discharge , brownish yellow( case of atrophic vaginitis but rule out malignancy by hysteroscopy). Discussion of cases: case 2 discussion : 6 month old baby, presented to ED after having diarrhoea. take relevant history , ask for examination finding and counsel the mother. This case was not as straight forward as it looks like and as i had mentioned before that whenever there is a paediatric case always take proper history.

the history is that 6 month old baby has been having diarrhoea for past 2 days, listless, fussy, crying and difficult to handle. feeding fine.60th percentile for weight and length. diarrhoea profuse , 8 to 10 motions. no blood. 2 siblings had mild diarrhoea 3 days back but self limiting. baby is fussy but drinking fine and not lethargic. BUT THERE IS A DECREASE IN NUMBER OF NAPPIES CHANGED SINCE YESTERDAY. when asked for immunization BABY IS NOT IMMUNIZED AS SOMEONE TOLD THE MOTHER THAT HOMEOPATHIC VACCINES ARE AS POTENT AS NORMAL VACCINE. EXAMINATION FINDINGS: FUSSY BABY. VITALS NORMAL. SKIN TURGOR NORMAL, FONTENELLE NOT DEPRESSED AND EYES NOT SUNKEN. MUCOUS MEMBRANES DRY . REST OF THE GENERAL PHYSICAL EXAMINATION UNREMARKABLE. URINE DIPSTICK: KETONE POSITIVE in this case i counselled the mother that baby has to have immunization and i will refer the case to immunization nurse. also baby is mildly dehydrated secondary to rota virus infection and can be managed at home but since there is suspected decrease in urine output as well as urine ketone positive so i will not be very comfortable at sending him home at this moment but will monitor his urine output along with hospital based rehydration and if everything is normal he can be sent home. also, there is no danger to baby's life if water, salts are replaced appropriately as virus wont pose a danger to his life but dehydration will. then when i asked her do u have any more questions : she asked " would immunization could have prevented this episode?" i said no but immunization is important as it prevents other more life threatening

diseases. case 3 : 23 year old female , 20 weeks pregnant, has been overseas with no investigations done in the past. the current uterine size is 30cm, rest of the general physical examination normal. talk to mother and manage. well guys the basic mistake which we all do in this case is that we assume that its polyhydroamnios and formulate a plan according to that and thus we are given a unsatisfactory mary, which doesnt mean a fail, but increase the chances of fail if we commit further mistakes. now whenever dealing with a aussie pregnant female always remember following things: always ask blood group. always ask about immunization. always ask weather the pregnancy was planned or unplanned. always ask weather she had any antenatal checkup and if not then organize blood group, CBE, rubella antibodies level, VDRL, gonorrhoea serology, HIV and if Rh negative then get a coomb's indirect and urine microscopy and culture. always ask about previous pregnancies and outcomes. now this female is 20 weeks pregnant, not been investigated and has a uterine size of 30cm, thus she is large for gestational age and not polyhydroamnios. i told the mother that your uterine size is greater than expected for this gestational age and most common case for this is wrong dates. ( with this statement the examiner was overtly happy as if became so emotional that she was about to kiss me and say bless you my child "bravo" haha). now i told that but we have to rule out more sinister causes which can give you the increased uterine size: polyhydroamnios secondary to neural tube defects, GI abnormalities, infection. Blood group mismatch giving hydrops fetalis ( unlikely as mother is O positive and its her first pregnancy) twin pregnancy diabetes uterine fibroids

first thing is that since you havent had any investigations done i would like to do all the antenatal investigations . secondly i need to organize a ultrasound to rule out twins, hydrops, fibroids. will do a glucose challange test to check for deranged BSL. will review in few days time , as soon as the blood results and ultrasound are back and if required refer

you to obstetrician. the examiner was happy and so was patient. March 2009 cases list Adelaide 1. Postnatal depression 2. Anorexia nervosa 3. Ovarian cyst 4. Plyhydramnios 5. Atrophic vaginitis 6. Knee pain/ irritable hip 7. Diarrhoea 8. Anaemia ( due to ?) 9. Pneumothorax 10. Rheumatoid arthritis 11. Pleumorphic adenoma 12. chr. diarrhoea 13. Trauma Mx 14. Visual problem 15. Prostate BPH 16. Infective endocarditis