Station - Instructions for candidate
You are a medical student on placement in the Emergency Department at Royal Perth Hospital.
Enzo Rossi, a 54-year-old man, presents to the Royal Perth Hospital Emergency Department with two episodes of dark vomit and three days of black stools. He has had several months of upper abdominal discomfort. His initial observations are pulse 104 beats per minute, blood pressure 118/70 mmHg, respiratory rate 18 breaths per minute, oxygen saturation 98% on room air and temperature 36.8 degrees C. Blood tests are printed on the candidate sheet.
Results provided:
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 82 | 130-180 g/L |
| Haematocrit | 0.25 | 0.40-0.54 |
| White cell count | 6.8 | 4.0-11.0 x 10^9/L |
| Platelets | 286 | 150-400 x 10^9/L |
| Urea | 15.2 | 2.5-8.0 mmol/L |
| Creatinine | 92 | 60-110 umol/L |
| Sodium | 5.1 | 135-145 mmol/L |
| Potassium | 4.4 | 3.5-5.0 mmol/L |
| INR | 1.1 | 0.9-1.2 |
| ALT | 24 | 5-40 U/L |
| ALP | 28 | 30-110 U/L |
| Bilirubin | 14 | 3-20 umol/L |
| CRP | 4 | <5 mg/L |
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, including haemodynamic assessment, abdominal examination and a search for peripheral stigmata of chronic liver disease. Describe to the examiner what you would examine and the relevant findings will be provided.
- Interpret the blood test results provided on the candidate sheet.
- State the most likely diagnosis and two to four relevant differentials, with brief justification.
- Outline the initial management plan, including resuscitation, medication changes, referral and safety-netting.
- Summarise your findings, assessment and initial management plan to the examiner.
- You do NOT need to perform a rectal examination.
- Please verbalise your examination to the examiner; findings will be provided as you request each relevant step.
- You do not need to prescribe or write in the notes.
- The examiner will not ask questions; you must provide your summary before the end of the station.
This is a 15-minute station, with 2 minutes of reading time.