Station - Instructions for candidate
You are a medical student on placement in the Emergency Department at Fiona Stanley Hospital.
Rosetta Fenech, a 52-year-old woman, has presented to the Emergency Department with three days of yellow eyes and itch after several months of intermittent right upper abdominal pain. Triage observations and blood-test results are provided.
| Triage observations | Triage observations: HR 86 regular, BP 132/78 mmHg, RR 16, SpO2 98% on room air, temperature 36.8 degrees C, pain score 2/10 |
|---|---|
| Nursing handover | The patient is alert, speaking comfortably and has no intravenous access yet. |
Results provided:
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 132 g/L | 115-155 g/L |
| White cell count | 8.4 x 10^9/L | 4.0-11.0 x 10^9/L |
| Platelets | 286 x 10^9/L | 150-400 x 10^9/L |
| CRP | 9 mg/L | <5 mg/L |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.1 mmol/L | 3.5-5.0 mmol/L |
| Urea | 5.8 mmol/L | 2.5-7.5 mmol/L |
| Creatinine | 71 umol/L | 45-90 umol/L |
| Total bilirubin | 86 umol/L | 3-20 umol/L |
| Conjugated bilirubin | 70 umol/L | 0-5 umol/L |
| ALP | 612 U/L | 30-110 U/L |
| GGT | 488 U/L | 5-40 U/L |
| ALT | 96 U/L | 5-35 U/L |
| AST | 78 U/L | 5-35 U/L |
| Albumin | 39 g/L | 35-50 g/L |
| Lipase | 42 U/L | 13-60 U/L |
| INR | 1.1 | 0.8-1.2 |
Your tasks are to:
- Take a focused history of the presenting problem and relevant background.
- Perform a focused examination of the peripheral stigmata, sclera and tongue, abdomen and right upper abdominal region. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- Interpret the provided blood-test results.
- State the most likely diagnosis and two to four differentials, with brief justification for each.
- Outline the initial management plan, including the key medication with dose and route, referral and safety-netting.
- You do NOT need to summarise your history and examination findings to the examiner before stating your diagnosis and management plan.
- You are not required to request additional investigations beyond interpreting the provided blood tests.
- Please verbalise your examination to the examiner; findings will be provided when you describe the relevant examination step.
This is a 15-minute station, with 2 minutes of reading time.