Station - Instructions for candidate
You are a general practice registrar in a Bunbury group practice.
Bao Nguyen, a 78-year-old retired orchardist, has been brought in by his daughter because he has been wetting the bed at night and dribbling during the day for a month. Three weeks ago another doctor in the practice started him on a bladder tablet for what the notes call an overactive bladder. A set of blood results taken two days ago is on the screen for review.
| Temperature | 36.6 degrees C |
|---|---|
| Heart rate | 82 beats/minute |
| Blood pressure | 138/80 mmHg |
| Respiratory rate | 16 breaths/minute |
| Oxygen saturation | 98% on room air |
Results provided:
Blood tests (two days ago, for review)
| Item | Value | Reference range |
|---|---|---|
| Sodium | 134 mmol/L | 135-145 mmol/L |
| Potassium | 5.6 mmol/L | 3.5-5.2 mmol/L |
| Urea | 18.4 mmol/L | 3.0-8.0 mmol/L |
| Creatinine | 214 umol/L | 60-110 umol/L |
| Baseline creatinine (last year's results) | 96 umol/L | 60-110 umol/L |
| Estimated glomerular filtration rate | 26 mL/min/1.73m2 | >90 mL/min/1.73m2 |
| Haemoglobin | 112 g/L | 130-180 g/L |
Your tasks are to:
- Take a focused history from the patient and his daughter.
- Perform a focused examination of the abdomen, external genitalia and rectum on the model provided. Describe to the examiner what you are looking for, and the relevant findings will be provided to you.
- Request any further investigations and interpret the results provided to you.
- State your most likely diagnosis with differentials to the examiner.
- Outline your initial management plan.
- Findings will be provided by the examiner on request.
- You do NOT need to summarise your findings to the examiner.
- You do not need to consent the patient for a procedure today, but explain what you propose to do next.
This is a 15-minute station, with 2 minutes of reading time.