Station - Instructions for candidate
You are a medical student on placement in a suburban Perth general practice.
Kevin Zhang, a 34-year-old man, has attended a suburban Perth general practice with eight months of recurrent burning discomfort behind his breastbone that rises towards his throat. He reports that it is particularly troublesome after evening meals and when lying down. No observations or investigation results are available at the start of the station.
Results provided:
ECG
| Item | Value | Reference range |
|---|---|---|
| Rate | 72 beats per minute | 60-100 beats per minute |
| Rhythm | Sinus rhythm | - |
| Axis | Normal | -30 to 90 degrees |
| P waves | Present and regular | - |
| PR interval | 160 ms | 120-200 ms |
| QRS duration and morphology | 92 ms, narrow QRS complexes | 70-120 ms |
| ST segments | No ST-segment elevation or depression | No significant deviation |
| T waves | No acute T-wave abnormalities | - |
| QTc | 410 ms | 350-450 ms |
A 12-lead ECG is available if specifically requested because of the retrosternal discomfort or concern about a cardiac cause.
ecg - read aloud by the examiner
A 12-lead tracing shows a regular rhythm at 72 beats per minute with narrow complexes. The electrical axis and intervals are within expected limits. There are no significant ST-segment or T-wave abnormalities.
Look up an example image: LITFL gastro-oesophageal reflux ECG
Helicobacter pylori stool antigen
| Item | Value | Reference range |
|---|---|---|
| Stool antigen | Negative | Negative |
A Helicobacter pylori stool antigen test is available if specifically requested as part of the upper gastrointestinal assessment.
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background, including medicines, allergies and social history.
- Perform a focused examination of the abdomen and epigastrium, including a general nutritional survey. Describe what you would examine to the examiner and the relevant findings will be provided to you.
- Request appropriate investigations. Results will be provided by the examiner if appropriately indicated.
- State your most likely diagnosis and two to four differentials, with brief justification for each.
- Outline your initial management plan, including treatment, follow-up and safety-netting.
- Summarise your findings to the examiner.
- Please verbalise the abdominal and nutritional examination to the examiner; findings will be provided as you request each part.
- You do NOT need to prescribe or write in the notes.
- The examiner will not ask you questions; include your diagnosis, management and summary in your responses.
This is a 15-minute station, with 2 minutes of reading time.