Station 1: Communication and management
Back pain- A 60 year old man presented with lower back pain, intermittent for the past 4 weeks. He took ibuprofen for pain control. On further questioning, he said he had a history of bowel cancer. He was given the all clear about a year ago. Discuss differential diagnosis and management.
Dx: Most likely bone mets
Station 2: Communication/ breaking bad new
Breaking bad news to the wife of 45 year old man, who collapsed at work. He was brought in to the ED with GCS of 11/15. He was intubated and you were told he got multiple mets in the brain with surrounding oedema. Chest x-ray showed lung ca. Prognosis is poor.
Issues with advance directive/ breaking bad new/DNAR
Station 3: Peadiatric resuscitation station
A 8 year old boy was trapped by a car. He had an obvious fracture on left tibia (The bone is sticking out). He was combative on arrival, and it was impossible to put a neck collar. How would you manage this case?
- ABCD approach.
- I gave analgesia- fentanyl IN but the agitation continued.
- Lorazepam IV given and the agitation stopped after 2nd dose of lorazepam.
- Anesthetist arrived after a few minutes and intubated the patient.
- Continue with the rest of ABCD approach
- 2nd survey
CT scan showed contusion on the left side. The rest of the CT scans were normal. CT scan of the lower limb showed obstruction just below the popliteal artery. The limb was splinted. X ray showed displaced fracture of tibia and fibula. You were expected to speak to the mother of the child or Orthopedic surgeon.
Station 4: Communication
History taking from the mother of a child who presented with left periorbital/orbital cellulitis. Discuss the diagnosis and management plan
Station 5: History and examination station
A 28 year old woman presented with painless visual loss on right eye. Please perform examination of the eye. There were fundoscope and snellen chart on the table, beside the patient.
Station 6: History taking
A 47 year old lady presented with palpitation and weight loss. Heart strip showed sinus tachycardia. Background history of DM.
Diagnosis of Hyperthyroidism
Station 7: NAI
A 2 year old girl presented to the ED with URTI. However on examination, she had a fracture of the elbow and multiple bruises on the thigh. The child was looked after by her grandparent and the mother’s ex-boyfriend. Discuss the management plan, and inform the suspicion of NAI to the mother.
Expect the unexpected!
Station 8: Teaching a junior doctor
Teach a doctor how to do procedural sedation for dislocated elbow.
Do not have to do the procedure.
Station 9: Resuscitation
Cardiac arrest in 60 year old man-VT. After 3 shock, amiodarone, adrenaline, there was a change of rhythm to sinus tachycardia. ECG showed STEMI.
Station 10: examination
Please do a peripheral nerve examination of the upper limb of a man who presented with wrist drop.
Diagnosis: radial nerve palsy
Station 11: History taking and examination
Middle age man presented with left claudication. You were expected to do vascular examination. Discuss management plan and diagnosis.
On further questioning, he said he injected heroin to the left groin a couple of days ago.
Unsafe department with 6 ambulances waiting outside ED, to off load their patients. You have to discuss how you want to manage the situation with a senior nurse, site manager and ambulance control person.
Station 13: Practical skill
Middle aged man presented with palpitation while running. ECG showed atrial fibrillation
Anaesthetist presented to help with DC cardioversion. After a second shock, there is a change of rhythm
Cant remember this one!
Edited by Dr T Hassan