Station - Instructions for candidate
You are a final-year medical student in a general practice in Bunbury.
Hung Tran is a 68-year-old man attending a general practice in Bunbury with six weeks of progressively deepening yellowing of his eyes and skin. Blood tests are printed on the candidate sheet. Take the history, perform the specified focused examination, interpret the results, give your diagnosis and differentials, and outline the initial management plan.
Results provided:
Liver function and coagulation tests
| Item | Value | Reference range |
|---|---|---|
| Total bilirubin | 186 umol/L | 3-20 umol/L |
| Conjugated bilirubin | 151 umol/L | 0-5 umol/L |
| Alkaline phosphatase | 642 U/L | 30-110 U/L |
| Gamma-glutamyl transferase | 811 U/L | 10-70 U/L |
| Alanine transaminase | 118 U/L | 5-40 U/L |
| Aspartate transaminase | 96 U/L | 5-40 U/L |
| Albumin | 31 g/L | 35-50 g/L |
| INR | 1.4 | 0.9-1.2 |
Full blood count and inflammatory markers
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 108 g/L | 130-175 g/L |
| White cell count | 9.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| Platelets | 398 x 10^9/L | 150-400 x 10^9/L |
| C-reactive protein | 18 mg/L | <5 mg/L |
Renal function and electrolytes
| Item | Value | Reference range |
|---|---|---|
| Sodium | 137 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Urea | 7.8 mmol/L | 2.5-8.0 mmol/L |
| Creatinine | 92 umol/L | 60-110 umol/L |
| eGFR | 71 mL/min/1.73 m2 | >90 mL/min/1.73 m2 |
Glycated haemoglobin
| Item | Value | Reference range |
|---|---|---|
| HbA1c | 63 mmol/mol | 20-41 mmol/mol |
Your tasks are to:
- Take a focused history of the presenting problem and relevant background, including medications, allergies and alcohol intake.
- Perform a focused examination for peripheral stigmata, scleral and tongue findings, and the abdomen. Describe to the examiner what you would examine and the relevant findings will be provided to you.
- Interpret the blood test results provided.
- State your most likely diagnosis and two to four differential diagnoses, with brief justification.
- Outline your initial management plan, including escalation, investigations, treatment and safety-netting.
- You do NOT need to summarise your findings to the examiner.
- 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 a prescription in this station.
- No imaging result is provided; state which urgent investigations and referrals you would arrange.
This is a 15-minute station, with 2 minutes of reading time.