Station - Instructions for candidate
You are an intern working in the Emergency Department of a metropolitan hospital in Perth. It is 10 am.
Kavya Patel, 70, has come in because for two weeks she has been increasingly breathless, especially lying down, and her ankles have swollen. She had a heart attack four years ago. She is sitting up on the trolley and is comfortable talking. The triage nurse has recorded observations.
| Triage note | 70 F. Two weeks of breathlessness worse lying flat, ankle swelling. Previous heart attack with stent 2022. Medicines as per patient: aspirin, atorvastatin. Category 3. |
|---|---|
| Observations | HR 96 /min regular, BP 148/88 mmHg, RR 22 /min, SpO2 92% on room air, T 36.8 degrees C, weight 72 kg |
Your tasks are to:
- Take a focused history.
- Perform a focused examination of the cardiovascular and respiratory systems and her fluid status. Verbalise each step and the examiner will provide findings.
- Request the investigations you need and interpret the results the examiner provides.
- State your most likely diagnosis, the precipitating factors, and the differential diagnoses to the examiner.
- Outline your initial management plan to the examiner, including drug doses and the treatment you would plan once she is stable, and explain the plan to Mrs Patel.
- You do NOT need to summarise your history and examination findings to the examiner.
- State drug, dose and route where relevant.
- A stethoscope, tape measure and torch are on the table.
This is a 15-minute station, with 2 minutes of reading time.