<\/p>\n
\u3053\u308c\u307e\u3067\u3001\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u533b\u5b66\u90e8\u306e\u6700\u7d42\u5b66\u5e74\u306e\u7814\u4fee\u3067\u3042\u308b\u3001\u9ebb\u9154\u79d1<\/a>\u3001\u7de9\u548c\u30b1\u30a2<\/a>\u3001\u816b\u760d\u79d1<\/a>\u3001\u8133\u5916\u79d1<\/a>\u3001\u3078\u304d\u5730\u533b\u7642<\/a>\u3001\u5916\u79d1<\/a>\u3001\u5185\u79d1<\/a>\u3001\u6551\u6025\u533b\u7642<\/a>\u306e\u8a71\u3092\u3057\u3066\u304d\u305f\u3002<\/p>\n <\/p>\n \u305d\u3057\u3066\u3001\u6b21\u306e\u30c6\u30fc\u30de\u3067\u3042\u308b\u300c\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\u533b\u5b66\u90e8\u3001\u5352\u696d\u306b\u5fc5\u8981\u306a\uff15\u3064\u306e\u3053\u3068\u300d\u306b\u3064\u3044\u3066\u8a71\u3092\u9032\u3081\u3066\u3044\u308b\u3002<\/p>\n <\/p>\n \u524d\u3005\u56de\u306e\u8a18\u4e8b\u300e\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\u533b\u5b66\u90e8\u3001\u5352\u696d\u306b\u5fc5\u8981\u306a\uff15\u3064\u306e\u3053\u3068\uff08\u533b\u7642\u884c\u70ba\uff09<\/a>\u300f\u3067\u306f\u3001\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\u533b\u5b66\u90e8\u3092\u5352\u696d\u3059\u308b\u306b\u306f\u533b\u7642\u884c\u70ba\u306e\u57fa\u672c\u3092\u7fd2\u5f97\u3057\u306a\u3051\u308c\u3070\u3044\u3051\u306a\u3044\u3001\u3068\u3044\u3046\u3053\u3068\u3092\u66f8\u3044\u305f\u3002<\/p>\n <\/p>\n \u524d\u56de\u306e\u8a18\u4e8b\u300e\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\u533b\u5b66\u90e8\u3001\u5352\u696d\u306b\u5fc5\u8981\u306a\uff15\u3064\u306e\u3053\u3068\uff08\u8ab2\u5916\u6d3b\u52d5\uff09<\/a>\u300f\u3067\u306f\u3001\u533b\u7642\u884c\u70ba\u306e\u7fd2\u5f97\u3060\u3051\u3067\u306a\u304f\u8ab2\u5916\u6d3b\u52d5\u3082\u5fc5\u9808\u3001\u3068\u3044\u3046\u3053\u3068\u3092\u66f8\u3044\u305f\u3002<\/p>\n <\/p>\n \u305d\u3057\u3066\u3001\uff13\u3064\u76ee\u306e\u30cf\u30fc\u30c9\u30eb\u3068\u306a\u308b\u306e\u304c\u3001\u5ba2\u89b3\u7684\u81e8\u5e8a\u80fd\u529b\u8a66\u9a13<\/span>\u3067\u3042\u308b\u3002<\/p>\n <\/p>\n \u5ba2\u89b3\u7684\u81e8\u5e8a\u80fd\u529b\u8a66\u9a13\u306f\u3001\u82f1\u8a9e\u3067 Objective Structured Clinical Examination\uff08OSCE\uff09\u3068\u547c\u3070\u308c\u308b\u3002\u5b66\u751f\u306f\u3001\u60a3\u8005\u3055\u3093\uff08\u30dc\u30e9\u30f3\u30c6\u30a3\u30a2\uff09\u3068\u63a1\u70b9\u8005\uff08\u533b\u8005\uff09\u304c\u3044\u308b\u90e8\u5c4b\u306b\u5165\u308a\u3001\u7d04\uff11\uff10\u5206\u9593\u3067\u8ab2\u3055\u308c\u305f\u8ab2\u984c\u3092\u3053\u306a\u3055\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002<\/p>\n <\/p>\n \u533b\u5b66\u90e8\u6700\u5f8c\u306e\u81e8\u5e8a\u8a66\u9a13\u3067\u3042\u308b\u305f\u3081\u3001\u6700\u7d42\u5b66\u5e74\u3067\u884c\u306a\u3063\u305f\u7814\u4fee\uff08\u9ebb\u9154\u79d1<\/a>\u3001\u7de9\u548c\u30b1\u30a2<\/a>\u3001\u816b\u760d\u79d1<\/a>\u3001\u8133\u5916\u79d1<\/a>\u3001\u3078\u304d\u5730\u533b\u7642<\/a>\u3001\u5916\u79d1\uff08\u8033\u9f3b\u54bd\u5589\u79d1\uff09<\/a>\u3001\u5185\u79d1\uff08\u5faa\u74b0\u5668\u5185\u79d1\uff09<\/a>\u3001\u6551\u6025\u533b\u7642<\/a>\uff09\u3060\u3051\u3067\u306a\u304f\u3001\u5148\u4f4f\u6c11\u533b\u7642<\/a>\u3001\u773c\u79d1<\/a>\u3001\u8001\u4eba\u79d1<\/a>\u3001\u30ea\u30a6\u30de\u30c1\u79d1<\/a>\u3001\u7cbe\u795e\u79d1<\/a>\u3001\u7523\u5a66\u4eba\u79d1<\/a>\u3001\u5c0f\u5150\u79d1<\/a>\u306a\u3069\uff14\u5e74\u9593\u3059\u3079\u3066\u306e\u7814\u4fee\u304c\u63a1\u70b9\u306e\u5bfe\u8c61\u3068\u306a\u308b\u3002\u307e\u305f\u3001\u305f\u3063\u305f\u6570\u5e74\u306e\u7814\u4fee\u3067\u3059\u3079\u3066\u306e\u75c7\u4f8b\u306b\u51fa\u4f1a\u3046\u3053\u3068\u306f\u4e0d\u53ef\u80fd\u306a\u306e\u3067\u3001\u305d\u308c\u4ee5\u5916\u306e\u75c5\u6c17\u306b\u3064\u3044\u3066\u306f\u81ea\u5206\u3067\u5b66\u7fd2\u3057\u3066\u304a\u304b\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u3002\u7e2b\u5408\u304c\u51fa\u3066\u304f\u308b\u304b\u3082\u3057\u308c\u306a\u3044\u3057\u3001\u80a9\u7532\u96e3\u7523\u3001\u6182\u9b31\u75c5\u306e\u554f\u8a3a\u3001\u304a\u3049\u3001\u8003\u3048\u59cb\u3081\u305f\u3089\u30ad\u30ea\u304c\u7121\u3044\u3050\u3089\u3044\u3002\u8a66\u9a13\u306b\u51fa\u3066\u304f\u308b\u53ef\u80fd\u6027\u304c\u3042\u308b\u30b7\u30ca\u30ea\u30aa\u306e\u6570\u304c\u3001\u76ee\u7729\u304c\u3059\u308b\u307b\u3069\u81a8\u5927\u306a\u306e\u3060\u3002<\/p>\n <\/p>\n <\/p>\n \u6b21\u306e\u52d5\u753b\u306f\u3001\u30bf\u30b9\u30de\u30cb\u30a2\u5927\u5b66<\/a>\u30fb\u533b\u5b66\u90e8<\/a>\u306e\u5973\u306e\u5b50\u3060\u3051\u3069\u3001\u3046\u3061\u306e\u5927\u5b66\u306e\u5ba2\u89b3\u7684\u81e8\u5e8a\u80fd\u529b\u8a66\u9a13\u3060\u3051\u3067\u306a\u304f\u3001\u3069\u3053\u306e\u5927\u5b66\u3067\u3082\u4f7f\u3048\u308b\u30a2\u30c9\u30d0\u30a4\u30b9\u3060\u3068\u601d\u3046\u306e\u3067\u3001\u305c\u3072\u53c2\u8003\u306b\u3057\u3066\u307b\u3057\u3044\u3002<\/p>\n <\/p>\n\n\n
\n\t \n\u5206\u91ce<\/th> \u5185\u5bb9<\/th>\n<\/tr>\n<\/thead>\n \n\t Ophthalmology<\/td> Chemical Burn
\n31 year old bricklayer who presented to ED with an acutely painful red eye after recently swiping their eye with mortar (contains lime \u2192 alkali burn). Was also expected to take further Hx e.g. eye protection?
\nSolely examiner in the room
\nPerform VA on examiner
\nFundoscopy of model\u2026 how many words can see in the model?
\nManagement of chemical injury\u2026. Had to tell examiner what you would do;
\nURGENT OPHTHAL REFERRAL
\nVisual Acuity
\nExtra-occular movements
\nEye inspection
\nPupils
\nPressure
\nProvide analgesia <\/td>\n<\/tr>\n\n\t General Practice<\/td> Acute Otitis Media
\n20 month old non-Indigenous child presented with fever and you had to speak to the Dad about symptoms. Shown images of disc bulging of R ear and L ear normal.
\nManagement
\nAnalgesia - pain stop\/paracetamol
\nR\/V in a few days
\n<\/td>\n<\/tr>\n\n\t General Practice<\/td> Breast Lump
\n49 year old woman from a rural town 2 hours away from hospital services presents to GP with breast lump in R breast. <\/td>\n<\/tr>\n\n\t General Practice<\/td> T2DM - lifestyle counselling
\n35 year old Shannon a Noongar (Aboriginal) lady who presents today for R\/V of her recently diagnosed T2DM.
\nTriggers stated:
\n1. Assess her compliance\/progress of lifestyle changes so far (or something like that)
\n2. \u201cDiscuss the barriers to patient improving her glycaemic control\u201d
\nShe is a single mother with 3 children and her mother lives with her. She works long hours at the local AMS and is
\nsometimes too tired to cook meals. <\/td>\n<\/tr>\n\n\t General medicine<\/td> Hypercalcaemia\/AKI\/Delirium
\n73 year old man brought into ED with 2 weeks of lethargy, confusion and nausea. B\/g of AF, T2DM and non-small cell lung cancer diagnosed in 2010.
\nExaminer shows hypercalcaemia on a B\/G of SCC Dx 3 years ago, increased urea and creatinine, slightly raised hyperkalaemia. Raised ALP, GGT. FBC normal, WCC normal, coagulation profile normal.
\n\u25cf Talk through top DDx, and why so?
\n\u25cf What other investigations would you have ordered
\n\u25cf Mgmt. of the hypercalcaemia (IVH, diuretics, bisphosphonates + calcitriol?)<\/td>\n<\/tr>\n\n\t Paediatrics<\/td> Paediatric Resuscitation
\n3 year old post-drowning is brought into ED by ambulance and the student nurse can help with CPR but is unsure how to perform it.
\nHad to correct technique of student nurse as he was too slow
\nWas also expected to bag the kid for a few cycles at my site. Nurse takes over after a couple. Was also suction available but was nothing to suction when you did Airway assessment.
\nSome variation between stations but at mine (Ozzy Park) the defib was \u2018on the way\u2019 when you asked about it. Was a cardiac trace that showed asystole. Had to give weight appropriate adrenaline dose (20kg = 200mcg?) to get ROSC.
\nAfter achieve ROSC paeds come and take over care (defib still \u2018on the way\u2019 at this point smh lol).<\/td>\n<\/tr>\n\n\t Paediatrics<\/td> Non Accidental Injury
\nMother presents with her 2 month child with NAI from step-father. When asked about the mechanism of injury said that she wasn\u2019t actually there, it was the step-father looking after him alone. Generally very vague about the Hx\/mechanism when asked. Baby from previous relationship, when asked Mum sometimes feels unsafe at home but okay as long as do things \u2018his (the partners) way\u2019.
\nXR showed complete femur #<\/td>\n<\/tr>\n\n\t Surgery<\/td> Small Bowel Obstruction
\n60 year old Mr Parson\u2019s has had intermittent, crampy pain (3\/10) for the past 2 weeks and now has now not passed flatulence.
\nPerform Abdo Exam and answer examiner\u2019s questions
\n- guy was meant to have a scar from hemicolectomy
\n- vital signs (by bedside) were all okay, slightly hypertensive and tachycardic
\nGet given AXR \u2192 it\u2019s SBO
\n- Prep the guy for theatre (drip & suck, IVH, bloods, ECG, call reg + theatre, etc.)<\/td>\n<\/tr>\n\n\t Surgery (Ear Nose Throat)<\/td> Sudden sensorineural hearing loss
\n\u25cf Trigger: 43 y\/o lady present with acute onset of ringing and hearing loss on right ear.
\n\u25cf Perform rinne and weber to determine what type of hearing loss
\n\u25cf Questions on the different DDX of acute sensorineural loss
\n\u25cf Also asked about immediate + follow-up mgmt. (steroids + ENT referral + MRI\/CT pretty sure)<\/td>\n<\/tr>\n\n\t Surgery \/ Anaesthetics<\/td> Compartment Syndrome
\nTibial # 6h ago for ORIF 1\/7. Presents with marked escalation of pain in the affected limb.
\n\u25cf Compartment Syndrome - follow the WHO ladder for analgesia and management.
\n\u25cf Trigger was a bit vague but they were looking for you to take a quick history, go over your examination and management. Think key points were to go through the 5P\u2019s in the limb and consider emergent fasciotomy.
\n\u25cf Spanner was thrown in the works for us - Examiner asked \u2018if your reg said not to worry about it, put the cast back and we\u2019ll see them tomorrow. What would your response be?\u2019 - essentially just had to say that you wouldn\u2019t be comfortable with that and that you should insist the patient be seen now.<\/td>\n<\/tr>\n\n\t Emergency Medicine<\/td> Breaking Bad News
\nMrs Jones 83 year old female is found unresponsive following a bell alarm triggered which the nurse answered. She knows nothing about the patient and wants to know if she should continue CPR.
\n\u25cf She had a NOF# several days ago
\n\u25cf ?PE
\n\u25cf There was a completed ED admission form and her old file underneath it which had an Advance Health
\nDirective which states that the patient DOESN\u2019T consent to CPR, intubation or ICU\/HDU admission.
\n\u25cf Then the nurse turned into the daughter and you had to explain that her mother had passed away suddenly
\n\u25cf Essentially it was a \u201cbreaking bad news\u201d station so I used the SPIKES format and offered time with her mother to say goodbyes, if she wanted me to call a family or friend, chaplain etc <\/td>\n<\/tr>\n\n\t Emergency Medicine<\/td> Humerus Fracture
\n72 year old female presents after slipping over and falling on her shoulder. She is waiting in the non-acute section of ED please perform a targeted examination and tell the examiner your management.
\nIt was a closed neck of humerus # and you had to explain to the examiner the findings on the X-Ray
\nManagement
\nAnalgesia
\nOrtho R\/V
\nThere were different types of equipment available e.g. collar n cuff, cotton sling with pins and materials for casting.
\nYou had to decide which to put on her. <\/td>\n<\/tr>\n\n\t Psychiatry<\/td> Psychosis (drug induced? FEP?)
\n\u25cf Young girl in 20s
\n\u25cf 6-8 months of paranoia\/auditory delusions - can hear groups of people talking about her
\n\u25cf Also permeation of ego boundaries (said TV\/radio were reading her thoughts or something along those lines)
\n\u25cf 3x cannabis\/week
\n\u25cf Nil psych Hx, medical Hx, FHx - takes \u2018some drug the GP prescribed me to help me relax\u2019
\n\u25cf Nil Sx of a mood\/anxiety d\/o
\n\u25cf I went with schizophrenia since she had first order symptoms. DIP was my second differential. Patient and examiner seemed happy with me as I was leaving so pretty sure that\u2019s what they were looking for <\/td>\n<\/tr>\n\n\t Obstetrics and Gynaecology<\/td> Gynae Triage - Read over the patient list, prioritise and give your primary Dx, discuss the Mx of one case (SHOCK patient ?ectopic pregnancy - [pt D])
\n\u25cb YOU HAVE YOURSELF (RMO), REGISTRAR (EXAMINER), AND AN ED NURSE AVAILABLE
\n\u25cb A - 48 year old lady with irregular periods. None for last 3 mo. Presents with heavy bleed. Has brought in a towel soaked with blood with her. Obs are stable.
\n\u25cb B - young lady with twin pregnancy. +++ vomiting. Urinary ketones. Complaining and demanding to be seen by someone.
\n\u25cb C - 17 year old with vaginal discharge and fever. Obs are stable with BP ~110\/80. I got a strong sense that this was an endometritis\/PID picture.
\n\u25cb D - young lady with acute onset RIF pain. BP ~100\/70, tachycardic, resps 20, 96% RA.<\/td>\n<\/tr>\n\n\t Obstetrics and Gynaecology<\/td> Counselling for post-dates\/discuss risks and benefits of vaginal and c-section (40+5\/40)
\n\u25cb Just got asked a series of questions by patient regarding induction. Seemed to prompt us to go over options and discuss why going post 42 weeks would be a bad idea.<\/td>\n<\/tr>\n\n\t Oncology\/Palliative Care<\/td> Lady with New York Heart Association Class IV Congestive Heart Failure
\n\u25cf Refer to Pall. Care after prognosis of 6-12mths to live
\n\u25cf Already aware of prognosis. You are there to discuss the referral to pall care
\n\u25cf Patient main concerns were 1) breathlessness and 2) family were not coping
\n\u25cf Discussed with them what pall care was and how they can help at this point - symptomatic control of breathlessness and specialised SW support for family. Essentially just answered their questions about pall care.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n