Station - Instructions for candidate
You are a final-year medical student on placement in the Emergency Department at Fiona Stanley Hospital.
Achol Mading is a 46-year-old woman brought to the Emergency Department after a night of heavy drinking. She has had four episodes of forceful retching followed by two mouthfuls of fresh red blood. A triage handover and blood test results are provided.
| Nursing handover | Triage handover: one further small episode of fresh blood-stained vomit occurred after arrival in the Emergency Department. She is currently in a monitored cubicle. |
|---|---|
| Initial observations | Initial observations: HR 118 regular, BP 96/62 mmHg, RR 20, SpO2 97% on room air, temperature 36.8 degrees C, GCS 15, pain score 2/10. |
Results provided:
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 92 g/L | 115-155 g/L |
| Platelets | 88 x 10^9/L | 150-400 x 10^9/L |
| White cell count | 10.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| INR | 1.5 | 0.9-1.2 |
| Prothrombin time | 17 seconds | 10-14 seconds |
| Activated partial thromboplastin time | 34 seconds | 25-35 seconds |
| Fibrinogen | 2.1 g/L | 2.0-4.0 g/L |
| Bilirubin | 34 umol/L | 3-20 umol/L |
| Albumin | 28 g/L | 35-50 g/L |
| ALT | 68 U/L | 5-35 U/L |
| AST | 142 U/L | 5-35 U/L |
| ALP | 156 U/L | 30-110 U/L |
| GGT | 310 U/L | 5-40 U/L |
| Urea | 12.8 mmol/L | 2.5-7.8 mmol/L |
| Creatinine | 78 umol/L | 45-90 umol/L |
| Sodium | 134 mmol/L | 135-145 mmol/L |
| Potassium | 3.7 mmol/L | 3.5-5.2 mmol/L |
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background, including medicines, allergies and alcohol use.
- Perform a focused examination including haemodynamic assessment, abdominal examination and peripheral signs relevant to the presentation. Describe to the examiner what you would examine and the relevant findings will be provided to you.
- Interpret the provided blood test results.
- State your most likely diagnosis and two to four differentials, with brief justification for each.
- Outline your initial management plan, including resuscitation, medications, escalation and definitive referral.
- Summarise your findings and proposed plan to the examiner using a structured handover.
- You do NOT need to perform an endoscopy, insert a tube or obtain consent for a procedure today.
- You do not need to write prescriptions or calculate a transfusion volume; state the medicines, routes, doses and escalation you would use.
- Please verbalise your examination to the examiner, and provide your final summary using a structured handover.
- The examiner will provide examination findings when you request or demonstrate the relevant step.
This is a 15-minute station, with 2 minutes of reading time.