Station - Instructions for candidate
You are an intern covering the orthopaedic ward of a metropolitan hospital in Perth. It is 10 am.
Rosa/Salvatore Mancini, 49, is for theatre tomorrow. Nursing staff have asked you to review the patient, who is shaky and sweaty. The notes are on your sheet.
| Admission note (last night) | 49 y, fall on the footpath walking home, FOOSH, displaced distal radius fracture R, backslab applied, for ORIF tomorrow. CT head (for the fall): no acute abnormality. Social drinker. Smoker 20/day. No regular medicines. NKDA. Weight 74 kg. |
|---|---|
| Observations this morning | HR 112 /min, BP 162/98 mmHg, RR 18 /min, SpO2 97% on room air, T 37.4 degrees C, GCS 15, fingerprick glucose 4.4 mmol/L. Nurse's note: 'tremulous, sweating, vomited once, not sleeping, asking for something to calm down'. |
Your tasks are to:
- Take a focused history, including a detailed alcohol history.
- Perform a focused examination for the features of the condition you suspect, including tremor, sweating, pulse, orientation, gait and eye movements. Describe to the examiner what you are looking for; the findings will be provided.
- Request any investigations you consider necessary; the examiner will provide results where appropriate. State your most likely diagnosis and the differential diagnoses to the examiner.
- Outline your initial management plan to the examiner, including drugs with doses, routes and frequencies, and explain the plan to the patient.
- You do NOT need to summarise your findings to the examiner.
- The right wrist is in a backslab; you do not need to examine it.
- Plan the station: about 5 minutes for the history, 3 for the examination, and 7 for investigations, diagnosis and management.
This is a 15-minute station, with 2 minutes of reading time.