Station - Instructions for candidate
You are an intern on the general surgical team of a metropolitan hospital in Perth. It is 7 pm.
Kevin Liu, 19, has been in the Emergency Department since this afternoon with 18 hours of abdominal pain. The surgical registrar has diagnosed acute uncomplicated appendicitis on clinical grounds, bloods and ultrasound, and has booked him for a laparoscopic appendicectomy tonight. The registrar has asked you to take the pre-operative history and go through the consent discussion with Kevin; the registrar will join you to sign the form. Kevin has had analgesia and is comfortable. His parents are in the waiting room.
| Observations | HR 92 /min, BP 124/74 mmHg, T 37.9 degrees C, RR 16 /min, SpO2 99% on room air, weight 72 kg |
|---|---|
| Results | WCC 14.2 (neutrophils 11.8), CRP 45, Hb 148, UEC and LFT normal, lipase 30. Ultrasound: non-compressible blind-ending tubular structure 9 mm in the right iliac fossa with surrounding echogenic fat; no free fluid, no appendicolith, no collection. |
| Registrar's note | Acute uncomplicated appendicitis. For laparoscopic appendicectomy tonight. Nil by mouth. IV fluids. Cefazolin and metronidazole at induction. |
Your tasks are to:
- Take a brief history relevant to the operation and the anaesthetic.
- Explain the diagnosis and why the operation is recommended, in plain language.
- Obtain informed consent for the laparoscopic appendicectomy: the procedure, benefits, material risks, alternatives, what happens before and after, and Kevin's questions.
- You do NOT need to examine the patient, and you do NOT need to summarise your findings to the examiner.
- You do not need to complete the written consent form; the registrar will sign it with you.
- The anaesthetist will see Kevin separately; you should still cover the anaesthetic in outline.
This is a 10-minute station, with 2 minutes of reading time.