Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

STATION NUMBER: 3 ABDOMINAL CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING CANDIDATE INSTRUCTIONS Clinical reasoning 21% Clinical Interpretation examination 11% 68% You are the FY1 on the Acute Receiving Unit. The patient has presented with left sided loin pain. ● Clinical examination (19 marks): Perform a focussed abdominal exam on this patient. Tell the examiner what you are looking for and describe your findings as you go along. ● Data Interpretation (3 marks): The examiner will present you with imaging from this patient and ask you to interpret the scan. ● Clinical reasoning (6 marks): Answer the examiner’s two questions.STATION NUMBER: 3 ABDOMINAL CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING EXAMINER INSTRUCTIONS 1 Station timings: all stations are thirteen minutes in duration (ten minutes for undertaking the task, plus an additional three minutes to allow for feedback). You must not move candidates on to additional tasks during the station; they are responsible for managing their own time. A whistle will be sounded during the station as follows: - At the start: candidates have60 seconds toread thecandidate instructions outside the room - At one minute: candidates must enter the room and can commence their station tasks - At eight minutes: candidates have two minutes remaining to complete their tasks. - At ten minutes: candidates must end their tasks immediately. You have 3 minutes toprovide feedback on their performance and suggest areas of improvement if possible (help em’ out!) - At thirteen minutes: candidates must leave the room and move onto their next station. This is the same whistle as whistle 1, and candidates will have 60 seconds to read the candidate instructions outside the room If a candidate finishes the station early, they must remain in the station until the whistle is sounded at thirteen minutes. Feedback: during the station before the feedback session, you must not provide feedback to candidates at any time. If a candidate clearly misunderstands the instructions, simply ask them to “please re-read the instructions”. If, using your better judgement, you feel the candidate is struggling considerably during the station,you mayinsteadopt tousethetimetoteach thestation howtoundertakethetaskbeing assessed, and pass on any advice you may have. While examining candidates, only give a mark if the task is completed accurately by shading the appropriate circle. If the task is not attempted, incomplete or inadequately performed do not award the mark. Please fill in the mark sheet contemporaneously as the candidate is performing the task. Grade the candidate as fail, borderline, pass, or good pass.STATION NUMBER: 3 ABDOMINAL CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING EXAMINER INSTRUCTIONS 2 Data Interpretation: After the candidate has examined the patient, you should hand them the imaging – and advise them that “theseresults arefromthis patient,please tell me what type of scan this is and describe two abnormal findings”. Clinical Reasoning: Next, you should ask the candidates the following four questions: Q1. Which type of kidney stone is radio-lucent? Q2. Name two risk factors for developing kidney stones. Q3. Which drug would you prescribe to manage the pain in this patient? Q4. Describe two definitive management options for treating kidney stones.STATION NUMBER: 3 ABDOMINAL CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING ACTOR INSTRUCTIONS Name: Moira/Matthew Brown Age: 37 years old Thank you for allowing candidates to examine you. Candidates have been instructed to perform a focussed abdominal examination. Thisrequiresyouto exposeyour abdomenandthrorax.Pleasediscussthiswiththe examiner before commencing the station to ensure both are in agreement regarding the extent of exposure you will use for this examination (bare-chested, or over clothing). This will ensure consistentguidance can be given by examiners if candidates get confused when performing general inspection. Candidates have been told that you have presented with left sided loin pain and have been asked to examine your abdomen. Please state that you have pain in this area when asked. Please co-operate with the candidates, without giving any hints or assistance to them.STATION NUMBER: 3 RESPIRATORY CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING Task Done/Correct Introduces self, identifies patient, explains procedure and obtains cOnsent Don/Doffs PPE accordingly during station O Clinical Examination: Inspection: scars O1 Inspection: looks for signs of GI disease on chest eg spider naevi, O1 gynecomastia, hair loss Inspection: looks for signs of GI disease on abdomen eg Grey-Turner’sO1 striae, abdominal distension, hernia, stoma Palpation: ask if patient has any pain O1 Palpation: light palpation across nine regions O1 Palpation: deep palpation across nine regions O1 Palpation: liver edge O1 Palpation: border of spleen O1 Palpation: ballots kidneys O1 Palpation: gallbladder O1 Palpation: abdominal aorta for expansile mass O1 Palpation: pedal oedema O1 Palpation: left supraclavicular lymph node O1 Percussion: liver borders O1 Percussion: splenic edge O1 Auscultation: auscultates abdominal aorta O1 Auscultation: auscultates renal arteries O1 Auscultation: bowel sounds O1 All clinical findings accurate O1 Data Interpretation: Identifies CT KUB (non-contrast) O1 Identifies left ureteric stone O1 Identifies left sided hydronephrosis O1 Clinical Reasoning:Q1. Which type of kidney stone is radio-lucent? Urate O1 Q2. Name two risk factors for developing kidney stones.: Dehydration, male sex, obesity, structural abnormality of the renal tract, cystinuria, renal tubular acidosis, hyperparathyroidism O1 O1 Q3. What drug would you prescribe to manage the pain in this patient? O1 Diclofenac Q4. Name two definitive management options for treating kidney O1 O1 stones.: percutaneous nephrolithotomy, ESWL, ureteroscopy, open surgery Overall Assessment of Performance: Fail O Borderline O Pass O Good Pass OSTATION NUMBER: 3 ABDOMINAL CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING PATIENT’S IMAGING