Station - Instructions for candidate
You are a final-year medical student on placement in the Emergency Department at Royal Perth Hospital.
Nadia Haddad is an 83-year-old woman with moderate dementia and type 2 diabetes who has been brought to the Emergency Department by her daughter after two days of vomiting, abdominal swelling and reduced oral intake. She takes regular paracetamol and a slow-release pain medicine for knee arthritis. She had an appendicectomy many years ago.
| Triage handover | Brought to the Emergency Department by her daughter because of two days of vomiting, abdominal swelling and reduced oral intake. |
|---|---|
| Collateral information | The daughter reports that the patient has moderate dementia and may under-report pain or give an unreliable timeline. |
Your tasks are to:
- Take a focused history of the presenting problem and relevant background from the patient and her daughter.
- Perform a focused examination of the peripheries, abdomen, hernial orifices and rectum. Describe what you would examine and the relevant findings will be provided by the examiner.
- Request appropriate imaging and interpret the result provided by the examiner when appropriately requested.
- State the most likely diagnosis and two to four relevant differentials, with brief justification.
- Outline the initial management plan, including immediate treatment, analgesia, escalation and referral.
- Summarise your findings, interpretation and immediate plan to the examiner.
- Please obtain collateral history from the patient's daughter as well as speaking respectfully to the patient.
- Please verbalise each examination component to the examiner; findings will be provided when you request the relevant step.
- You do not need to prescribe, perform a procedure, or write a formal operation consent form in this station.
- No examiner questions will be asked; include your diagnosis, management and summary within the station time.
This is a 15-minute station, with 2 minutes of reading time.