Station - Instructions for candidate
You are an intern working in the Emergency Department of a tertiary hospital in Perth.
Li Hua Wong, a 66-year-old retired landscaper, has been brought in by her daughter at 6 am with severe pain in her left eye and a headache since last night, blurred vision and repeated vomiting. She is in a cubicle with a vomit bag, and the nurse has recorded her observations. A Snellen chart, pen torch, fluorescein and a Tono-Pen (handheld tonometer) are available, and the on-call ophthalmology registrar can be contacted by phone.
| Observations at triage | Heart rate 96 /min, blood pressure 168/94 mmHg, respiratory rate 18 /min, SpO2 97% on room air, temperature 36.9 degrees C, pain 9/10 |
|---|---|
| Triage note | Left eye pain and headache since 2100, blurred vision, vomiting x3. Long-sighted. Category 2. |
Your tasks are to:
- Take a focused history.
- Perform a focused examination of the eyes, including visual acuity, inspection, the cornea, the pupils and an assessment of the pressure of the eye. Verbalise each step to the examiner and the findings will be provided.
- Request any investigations you would order now. Results will be provided by the examiner if appropriately indicated.
- State your most likely diagnosis and the differential diagnoses to the examiner.
- Outline your immediate management to the examiner, including the drugs you would give with doses and routes, and explain the plan to the patient.
- You do NOT need to summarise your history and examination findings to the examiner.
- State drug, dose and route for each treatment.
- The examiner may hand you results at any point after you request them.
This is a 15-minute station, with 2 minutes of reading time.