Station - Instructions for candidate
You are an intern on placement in the general surgical outpatient clinic at Fiona Stanley Hospital.
Barry Kowalczyk, a 71-year-old retired shearer, has been referred to the general surgical outpatient clinic after iron deficiency anaemia was found on pre-operative blood tests for a planned knee replacement. He says he feels well and has attended to discuss the abnormal blood result.
| Referral information | Your patient is attending the general surgical outpatient clinic after iron deficiency anaemia was identified on pre-operative blood tests for planned knee replacement surgery. |
|---|
Results provided:
Blood tests and faecal occult blood test
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 96 g/L | 130-170 g/L |
| MCV | 74 fL | 80-100 fL |
| Ferritin | 7 microgram/L | 30-400 microgram/L |
| Serum iron | 18 umol/L | 10-30 umol/L |
| Faecal occult blood test | Positive | Negative |
Upper gastrointestinal endoscopy
Irregular friable narrowing at the gastro-oesophageal junction, extending for approximately 4 cm. The endoscope passes with gentle pressure. Multiple biopsies were taken.
imaging other - read aloud by the examiner
The report describes an irregular, friable narrowing at the junction between the food pipe and the stomach. The narrowing extends for approximately 4 cm, and several tissue samples were taken.
Look up an example image: Radiopaedia oesophageal cancer endoscopy
Endoscopic biopsy histology
Invasive moderately differentiated adenocarcinoma involving the distal oesophageal mucosa and submucosa. HER2 and PD-L1 testing pending.
CT chest, abdomen and pelvis
Circumferential distal oesophageal wall thickening over 5 cm, with two enlarged regional para-oesophageal lymph nodes. No focal liver lesions, lung metastases or peritoneal disease.
imaging other - read aloud by the examiner
The scan shows thickening around the lower part of the food pipe and two enlarged nearby lymph nodes. No spread is seen in the liver, lungs or lining of the abdomen.
Look up an example image: Radiopaedia oesophageal cancer CT
Your tasks are to:
- Take a focused history of the presenting problem and relevant background, including medications, allergies and social history.
- Perform a focused examination of the neck and supraclavicular fossae, followed by the abdomen and epigastrium. Describe what you would examine and the relevant findings will be provided by the examiner.
- Request appropriate investigations. Results will be provided by the examiner when appropriately indicated.
- State the most likely diagnosis and two to four differential diagnoses, with brief justification.
- Outline the initial management plan, including urgent referrals, investigations, supportive care and safety-netting.
- Summarise your findings and plan to the examiner.
- Please verbalise each examination step to the examiner; findings will be provided when you reach the relevant part of the examination.
- You do not need to perform a procedure or prescribe in the clinic today.
- The diagnosis and management plan must be summarised to the examiner at the end.
This is a 15-minute station, with 2 minutes of reading time.