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Station 1 - Student

Interpret this ECG

ECG 5 This ECGwas recorded from a 60-year-old woman with rheumatic heart disease. She had been in heart failure, but this had been treated and she was no longer breathless. What does the ECGshow and what question might you ask her?

Station 1 - Examiner
ECG interpretation (3 minutes) If student is unable to answer atrial brillation then say or if patient is able to answer AF-

Say this ECG showed AF, what questions would you ask to determines patient risk of stroke?

What treatment would you consider if this patient was a high risk of stroke?

Station 2 - Student

Station 2 - Examiner
1) Ask the student to interpret the CXR 2) What are some causes of this disorder 3) What investigation would you choose to investigate this disorder

Station 3 - Student
A 64yo female presents with a 2 month history of fatigue. A full blood picture is below Hb - ! ! MCV - ! MCH - ! MCHC Plt - ! ! WCC - ! 86 (135-180) 64 (80-100) 25 pg (27-32) ! 280 (320-360) 203 (150-400) 8.4 (4-11)

A 68yo female is admitted to the surgical ward with these Liver Function Tests Total bilirubin - 99 (<20) ALT - 34 (<40) ALP - 196 (<67) GGT - 100 (<60) Albumin - 41 (35-50)

Station 3 - Examiner
Full blood count 1) What time of anaemia does this patient have? 2) Name some causes of this type of anaemia 3) In iron deecient anaemia, would you expect the following to be high, low or normal in this patient a) Serum Iron b) Total iron binding capacity Liver Function Test 1) Interpret the liver function test 2) What symptoms may you expect this patient to have? 3) Name some causes of this abnormality 4) What is the 1st test you should order?

Station 4 - Student
You are a GP. You have a follow-up with a 70yo male who has 3 month history of epigastric discomfort and 10kg weight loss. Investigations you have organised show pancreatic cancer with bone metastases.

Explain what these ndings show to the patient and give the bad news.

Station 4 - Examiner
You have a 3 month history of epigastric discomfort and weight loss and student will be giving you the ndings of previous investigations (pancreatic cancer with bony metastases). Ask the student 1) What can I expect? 2) What is my life expentancy?

Station 5 - Student
You are a GP, you have taken over the care of a 65yo patient with type II diabetes Take a focused history in regards to the patients diabetes. The patient also has some blood and urine test arranged, please explain to the patient was these blood tests mean, and what management changes you would like to make.

Station 5 - Examiner
You are a 65 yo type II diabetic. The student has been asked to take a focused diabetic history You check your sugars before breakfast, lunch and dinner. Your BSL are 7-8 mane, 8-10 midi and 9-10 nocte. You had your eyes check last year and the opthomologist says your eyes are normal. You have had your feet checked by the podiatrist 2 months ago, and they were normal. You have no past medical history apart from type 2 diabetes. There is no history of heart disease or strokes. You have no numbness in your hands or feet. You do not have any dizziness. The only medications that you are on are metformin 1 g tds You have a brother who has type II diabetes, but there is no family history of stroke or heart disease. At 5 minutes, show your student your blood tests if they havent asked for your hbA1c. Ask them if they are going to change your medications.

Blood pressure - 130/70 Blood tests FBC Hb - 139 (115-160) WCC - 8 (4-11) Plt - 256 (150-400) U+E Na - 138 (134-146) K - 4.3 (3.4-5) Urea - 5.8 (3-8) Creatinine - 64 (45-90) Lipids Cholesterol - 5 (<5.5) Triglycerides 1.3 (<1.7) HDL 1.1 (>1.0) LDL 2.8 (<3) Urine albumin/Creat ratio - 11.5 (<3.5) Fasting BSL - 11

HbA1c - 8 (<6%)

Station 6 - Student
You are asked to see a 70 year old smoker who has had an increasing cough. Please interpret this CXR

How would you investigate this problem.

Please consent this patient for this investigation

Station 6 - Examiner
You are a 70 year old smoker who is concerned you have cancer. Ask the student what does the chest XR mean Ask the student how you are going to investigate for this.

Station 7 - Student
You are an ED RMO. You have been asked to interpret an ECG.

What blood tests would you like to order?

The nurse will give you the blood results. What treatment would you like to start?

Station 7 - Examiner
You are an emergency nurse. You have done an ECG and bloods for a patient. Show the student the ECG rst and ask to interpret the ECG The student will then ask to organise some blood tests. Once the student has listed what he wants, show them the blood tests that you have

FBC Hb - 140 (135-150) WCC - 7 (4-8) Plt - 160 (150-400) U+E Na - 142 (130-145) K - 8 (3.5-5) Urea - 7 (4-8) Cr - 70 (45-90)

Station 8
Interpret these pulmonary function tests

Station 9 - Student
Interpret this ABG from this 18yo female pH - 7 (7.35-7.45) Pa02 - 90 (80-100) Pa C02 - 25 (35-45) HC03 - 10 (22-28)

Station - 9 - Examiner
Ask the student to interpret the ABG Ask the student what could cause this abnormalities. After this tell the student this patient has diabetic ketoacidosis. Ask how they would manage this patient and what should they be monitoring.

Station 10 - Student
Interpret this CT head What symptoms may you expect? What further tests would you order?