Station - Instructions for candidate
You are an intern in the Emergency Department of Kalgoorlie Health Campus.
Bruno Zammit, a 74-year-old retired aged care worker, has been brought in by his daughter. He has been not himself for two days - muddled, off his food and complaining of a dull ache in his right side. He has type 2 diabetes and takes tablets for his blood pressure and blood sugar. Triage observations and a bedside urine test are on the notes in front of you.
| Temperature | 36.4 degrees C |
|---|---|
| Heart rate | 104 beats/minute |
| Blood pressure | 96/58 mmHg |
| Respiratory rate | 20 breaths/minute |
| Oxygen saturation | 96% on room air |
| Blood glucose level | 12.4 mmol/L |
| Conscious state | Alert, mildly confused to time and place |
Results provided:
Urinalysis
| Item | Value | Reference range |
|---|---|---|
| Leucocytes | 3+ | negative |
| Nitrites | Positive | negative |
| Blood | 1+ | negative |
| Protein | Trace | negative |
| Ketones | Negative | negative |
| Glucose | Negative | negative |
Your tasks are to:
- Take a focused history from the patient and his daughter.
- Perform a focused examination of the abdomen and renal angles. Describe to the examiner what you are looking for, and the relevant findings will be provided to you.
- Request any relevant investigations. Results will be provided by the examiner if appropriately indicated.
- Interpret the results provided to you.
- Outline your immediate management plan, including escalation and referral.
- Summarise your findings and differential diagnoses to the examiner.
- Findings will be provided by the examiner on request.
- You are not required to perform a rectal, genital or full neurological examination in this station.
- You do not need to consent the patient for a procedure today.
This is a 15-minute station, with 2 minutes of reading time.