Station - Instructions for candidate
You are a final-year medical student on placement in the Emergency Department at Bunbury Regional Hospital.
Rosanna Petrucci is a 54-year-old woman in the Emergency Department with 36 hours of severe constant pain in the upper abdomen, mainly in the epigastrium and right upper quadrant, with repeated vomiting. The triage nurse has handed over that she appears uncomfortable.
| Nursing handover | The patient is in an Emergency Department cubicle and appears uncomfortable. The triage nurse reports repeated vomiting since yesterday. |
|---|
Results provided:
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Pancreatic enzyme | Pancreatic enzyme 1420 U/L | 13-60 U/L |
| ALT | ALT 210 U/L | 5-35 U/L |
| ALP | ALP 240 U/L | 30-110 U/L |
| Bilirubin | Bilirubin 48 umol/L | 3-20 umol/L |
| FBC | WCC 15.2 x 10^9/L; neutrophils 13.1 x 10^9/L | WCC 4.0-11.0 x 10^9/L; neutrophils 2.0-7.5 x 10^9/L |
| CRP | CRP 168 mg/L | <5 mg/L |
| UEC | Na 136 mmol/L; K 3.7 mmol/L; urea 9.8 mmol/L; creatinine 118 umol/L | Na 135-145 mmol/L; K 3.5-5.2 mmol/L; urea 2.5-7.8 mmol/L; creatinine 45-90 umol/L |
| VBG | Venous pH 7.34; lactate 2.4 mmol/L; glucose 8.6 mmol/L | pH 7.31-7.41; lactate 0.5-2.0 mmol/L; glucose 3.5-7.8 mmol/L |
| Calcium | Corrected calcium 2.08 mmol/L | 2.15-2.55 mmol/L |
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background.
- Perform a focused abdominal examination, including the epigastrium and Murphy's sign. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- Request relevant blood tests and interpret the results provided by the examiner.
- State your most likely diagnosis and two to four differentials, with brief justification.
- Outline your initial management plan, including analgesia, monitoring, escalation and referral.
- 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 or demonstrate the relevant step.
- You do not need to prescribe, write medication orders or perform an internal examination.
This is a 15-minute station, with 2 minutes of reading time.