Station - Instructions for candidate
You are a medical student on placement in the Emergency Department at Fiona Stanley Hospital.
Hao Zhang, a 20-year-old man, presents to the Emergency Department with 18 hours of abdominal pain that began around the umbilicus and is now in the right lower abdomen. He has had reduced appetite and one episode of vomiting. The triage nurse has recorded the observations provided below.
| Triage handover | Triage observations: heart rate 104 beats/minute, blood pressure 126/74 mmHg, respiratory rate 18 breaths/minute, SpO2 99% on room air, temperature 38.1 degrees C and pain score 7/10. |
|---|
Results provided:
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 146 g/L | 130-170 g/L |
| White cell count | 15.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| Neutrophils | 13.2 x 10^9/L | 2.0-7.5 x 10^9/L |
| Platelets | 310 x 10^9/L | 150-400 x 10^9/L |
| C-reactive protein | 72 mg/L | <5 mg/L |
| Sodium | 138 mmol/L | 135-145 mmol/L |
| Potassium | 4.1 mmol/L | 3.5-5.0 mmol/L |
| Urea | 5.8 mmol/L | 2.5-7.8 mmol/L |
| Creatinine | 78 umol/L | 60-110 umol/L |
| Bilirubin | 12 umol/L | <20 umol/L |
| Alkaline phosphatase | 82 U/L | 30-110 U/L |
| Alanine aminotransferase | 31 U/L | <40 U/L |
| Lipase | 34 U/L | <60 U/L |
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background, including medications and allergies.
- Perform a focused abdominal examination, including right iliac fossa signs. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- Request blood tests and interpret the results provided by the examiner when appropriately requested.
- State your most likely diagnosis and two to four differentials, with brief justification.
- Outline your initial management plan, including analgesia, antimicrobial therapy, referral and safety-netting.
- You do NOT need to summarise your history and examination findings to the examiner before stating your diagnosis and management plan.
- Please verbalise your examination to the examiner; findings will be provided when you request the relevant examination step.
- You do not need to write prescriptions or obtain formal consent for surgery.
- The examiner will not ask you questions at the end of the station.
This is a 15-minute station, with 2 minutes of reading time.