Station - Instructions for candidate
You are a medical student on placement in the Emergency Department at Fiona Stanley Hospital.
Sione Latu, a 29-year-old man, presents to the Emergency Department with three hours of sudden severe left loin pain radiating towards the groin. The pain comes in waves, he has vomited, and he has been unable to lie still on the trolley. The triage nurse has provided the observations and bedside urine result shown.
| Triage handover | At triage: HR 108 regular, BP 142/88 mmHg, RR 20, SpO2 99% on room air, temperature 36.8 degrees C, pain score 9/10. He is restless on the trolley and has vomited twice in the department. |
|---|
Results provided:
Urinalysis
| Item | Value | Reference range |
|---|---|---|
| Leucocytes | negative | negative |
| Nitrites | negative | negative |
| Protein | trace | negative |
| Blood | 3+ | negative |
| Glucose | negative | negative |
| Ketones | 2+ | negative |
| pH | 6.0 | 5.0-8.0 |
| Specific gravity | 1.030 | 1.005-1.030 |
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background, including medications and allergies.
- Perform a focused examination of the abdomen and renal angles. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- Interpret the urinalysis provided.
- State the most likely diagnosis and two to four differentials, with brief justification.
- Outline the initial management plan, including analgesia, investigations, referral and safety-netting.
- Summarise your findings to the examiner in a concise clinical summary.
- Please verbalise your examination to the examiner; examination findings will be provided as you request each relevant step.
- You do NOT need to request or interpret additional investigations beyond the urinalysis provided.
- You do not need to prescribe or write medication orders.
- Ensure your final summary includes your proposed diagnosis, differentials and immediate safety concerns.
This is a 15-minute station, with 2 minutes of reading time.