Station 1 - StudentInterpret this ECG

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

Station 1 - Examiner

ECG interpretation (3 minutes)

If student is unable to answer atrial fibrillation then say or if patient is able to answer AF-

“Say this ECG showed AF, what questions would you ask to determine’s 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 - ! ! 86 (135-180)MCV - ! 64 fl (80-100)MCH - ! 25 pg (27-32)MCHC - ! 280 (320-360)Plt - ! ! 203 (150-400)WCC - ! 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 - ExaminerFull blood count

1) What time of anaemia does this patient have?

2) Name some causes of this type of anaemia

3) In iron defiecient anaemia, would you expect the following to be high, low or normal in this patient

a) Serum Ironb) Total iron binding capacity

Liver Function Test1) Interpret the liver function test2) What symptoms may you expect this

patient to have?3) Name some causes of this abnormality4) What is the 1st test you should order?

Station 4 - StudentYou 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 findings show to the patient and give the bad news.

Station 4 - ExaminerYou have a 3 month history of epigastric discomfort and weight loss and student will be giving you the findings of previous investigations (pancreatic cancer with bony metastases).

Ask the student1) What can I expect?2) What is my life expentancy?

Station 5 - StudentYou 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 patient’s 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 - ExaminerYou are a 65 yo type II diabetic. The student has been asked to take a focused diabetic historyYou 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 haven’t 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 - StudentYou 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 - ExaminerYou 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 - StudentYou 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 - ExaminerYou are an emergency nurse. You have done an ECG and bloods for a patient.

Show the student the ECG first 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+ENa - 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 - StudentInterpret 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 - StudentInterpret this CT head

What symptoms may you expect?

What further tests would you order?