Recall 10 Feb 2014
Please notice that there was not any question from examiners!!!!!!!
I don't know whether that's good or bad, but I got resit.
1- 10 weeks pregnant woman had contact with child with Rubella. She does not know whether or not had Rubella or immunization. You're a GP
Explain condition and counsell patient. It was a book case.
I Explained about IgG and IgM +/- and it's implicationsadn consequences.
I forgot to talk about IgG and IgM - and that she'll need vaccine after delivery.
2- Picture showing back of child's thighs and buttock with Purpuric rash after a viral URTI.
(A case of Henoch- Schonlein purpura.) Book case.
Talk to mother about condition and management. You're in the ED
Explained everything about condition. Slight danger of kidney damage after condition.
When asked to examiner about results: All tests normal.
3- Middle age man with chest pain after exertion which subsides after resting. Take a history, give probable diagnosis/es and reasons.
You're a GP.
Non smoker patient who drinks 5-6 St Drinks a day. Not keen to reduce alcohol intake.
In history and examination: Nothing abnormal, except angina.
According to someone, there was a hist of maelena. I said angina due to aterosclerosis and DD could be valvular failure, arrithmias, etc.
4- Young man had MVA injured left side after a car pushed his car. Patient was brought by Ambulance. Stable, alert.
Perform Ph Ex in ED. Talk to patient. Chest and upper abdomen examination.
I forgot to do DRSABC, although I thought about it before going in.
OE: Chest examination normal.
Abdomen: Patient showed signs of pain when palpating left UQ.
Kidney punch negative.
Dif Diagnosis: Rib fracture, Spleen rupture, kidney rupture,...
5- Young man in GP setting CO chest pain. Take a Hist. Diagnosis, management.
It was a case of GOR.
6- In rural GP setting, child with fever and lethargy .
Take a hist, management, talkvto mother.
No relevant past history. BINDG normal.
OE: Lethargic child, pale, febrile, dehydrated, capillary return: 3 sec, no dyspnoea.
Skin: No rash
No meningeal signs.
Office test: Normal.
7- Contraception in Breastfeeding woman.
Young lady, breastfeeding, wants an effective contraceptive method.
She did not want any other method but Hormones.
On History: Normal 7Ps
=Explained about using Progesterone only methods and Mirena, Copper IUD.
8- SOB day after surgery cholecystectomy in a woman with Chronic bronchitis. Also CO pain in the right shoulder.
I knew there was sub-frenic collection as well, but again I forgot to talk about it.
I was given in a written paper all VS and clearly there was a drp in the O2 Sat.
Slight fever. The rest: Normal.
9- ED. Patient with back pain after heavy lifting. Perform PE.
Again I forgot to make patient to walk, walk in toes, heal, squat . X@##(&%..!!!!!!!!
Patient asked: is it a serious condition?
What should I do?
10- Mother in GP setting, complains that her little 10 YO girl is not the same for the past 3 months.
Child not performing well in school, not happy, not active as before. Everything in history and BINDG normal.
Has another sister who was a planned pregnancy, but not her.
When asked about home, mother started to cry and said the husband is drinking too much because his business is not going well, has abused her physically. Has not reported him to Police.
Denied husband abusing children. She works part time as teacher and child stays with father in the afternoons.
None else apart from family members at home.
I said I need to se child ASAP and refer you all to Social and child protective services.
A case of child abuse?
11- 3 months after giving birth, young woman has palpitations.Another colleague arranged tests and PE was normal.
ECG and all blood tests normal.
Talk to patient. Explain results. Make a Diagnosis.
Patient denied all symptoms of depression and psychosis.
By the opposite: very happy and coping well. Only said that she's worried that something bad could happen to her child and she had this anxious feeling in her chest.
No Financial or any problems at home.... I was lost.
-I think it was a case of post-partum anxiety, adjustment disorder???
12- GP setting .Young student with Hist of drug abuse and failed exams, presents with acute psychosis. Pat gave permission to talk to father , but asked not to disclose drug abuse to father.
Talk to father.
Only things asked by father: Is he using drugs? What are they gonna do to him in the Hospital?
13- GP setting. Young man CO sudden SOB.
Nothing in history apart from Allergy to Penicillins., but physic exam had fever and crackles in the right lower lung field and chest X ray shows large opacity in mid field and lower lung.
After that pat admitted have had flu 1 week before.
Case of pneumonia.
14- PR bleeding in 28 yo female patient.
Take a Hist. and management.
Nothing specific in the Hist, just had recent trip to Thailand and had diarrhoea.
Took a full hist and advised her.
Just a few drops of blood, nothing else relevant. Father had bowel cancer age 55.
After history, explained DD and advised colonoscopy 10 years before his father's bowel cancer.
15- Old man had stroke at home 2 hours ago and brought by ambulance 20 min ago.
Currently stable. Talk to wife in ED.
Explained what stroke means and how is management for treatment and follow up for recovery.
When asked do you understand? She said yes. Can you cope with situation? She said yes.
RP asked: Is he gonna die?
16- Rural GP setting.Woman living 300 Km from major hospital US shows grade 4 Placenta previa.
In history, no complicacions.
=Advised her need Caesarean section , no place for normal delivery.
Dear friends, as mentioned, No questions from examiners and only few from RP. I was calm in all cases and role players and examiners were nice although some of them are very old and with hearing aids and even though, they can't hear you.
Most of the time the examiner looks at you from a mirror, so you are not under pressure of being observed. Ah, and there was not observers!!!!!!!!
Believe me, the new centre is a beauty... and you feel very comfortable. If there's something bothering you... It's your mind playing with you, not role players, nor the examiners.