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STATION NUMBER: 6 CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING CANDIDATE INSTRUCTIONS You are the FY1 in the Acute Medical Receiving Unit. The patient has presented with shortness of breath. Please perform a focussed respiratory exam. You DO NOT have to measure pulse or respiratory rate. ● Clinical examination (16 marks): Perform a respiratory exam with the thoracic examination restricted to the back. Inform the examiner what you’re looking for and describe your findings as you go along. ● Data interpretation (5 marks): The examiner will present you with a chest x-ray from another patient and ask you to interpret the scan. ● Clinical reasoning (3 marks): Answer the examiner’s two questionsSTATION NUMBER: 6 CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING EXAMINER INSTRUCTIONS 1 Station timings: all stations are fourteen minutes in duration (one minute to read the task, 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 have 60 seconds to read the candidate instructions outside the room ● At one minute: candidates must enter the room and can commence their station tasks ● At nine minutes: candidates have two minutes remaining to complete their tasks. ● At eleven minutes: candidates must end their tasks immediately. You have 3 minutes to provide feedback on their performance and suggest areas of improvement if possible (help em’ out!) ● At fourteen 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 fourteen minutes. Feedback: 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”. 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 pas.STATION NUMBER: 6 CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING EXAMINER INSTRUCTIONS 2 Candidates have been informed that the thoracic component of the examination has been restricted to the back only. Could you please discuss with the actor if they would prefer to be bare-chested (when requested by candidates to do so for exposure), or if they would prefer to just raise the back of their T-shirt. If the latter is selected and a candidate appears confused when performing general inspection, you may assist the candidate by informing them that the patient’s top does not need to be removed for general inspection and that the thoracic examination is restricted to the back, and to otherwise proceed normally. Data Interpretation: Once the candidate has performed the clinical examination on the patient, please present them the attached chest X-ray, and ask them to do the following: “Please interpret the scan using a systematic approach and present your findings” Then ask them: D1. What is the most likely diagnosis? D2. How would this present on clinical examination? Clinical Reasoning: Once the candidate has completed the data interpretation, please ask them the following 2 questions: Q1. How do you quantify the severity of community-acquired pneumonia? Q2. How would you manage a patient with moderate-severe pneumonia?STATION NUMBER: 6 CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING ACTOR INSTRUCTIONS Thank you for allowing the candidates to examine you. Candidates have been informed that the thoracic component of the respiratory examination is restricted to the back, hence you will not need to be bare-chested if you do not wish. All that is required would be for you to raise the back of your shirt to expose your back when conducting the thoracic component of the examination. Please discuss this with the examiner before commencing the station to ensure you are both in agreement regarding the extent of exposure you will use for this examination (bare-chested, or simply raising back of the t-shirt). This will ensure consistent guidance can be given by examiners if candidates get confused when performing general inspection. Candidates have been told that you have presented with shortness of breath and have been asked to examine you. Please co-operate with the candidates, without giving any hints or assistance to themSTATION NUMBER: 6 CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONING Task Done/Correct Introduces self; Confirms patient details; Explains to patient about thO1 procedure and obtains consent Dons/Doffs PPE and ‘washes hands’ O1 Clinical examination General inspection: O1 Patient (difficulty breathing, cyanosis, cough, wheeze) Environment (oxygen, cigarettes, nebulisers, inhalers, sputum pot) O1 Inspection: Chest mark given for any two mentioned O1 Scars/Chest wall deformities/Chest wall movement with breathing Inspection: Hands mark given for any two mentioned O1 Temperature/Clubbing/Peripheral cyanosis/Tobacco staining Inspection: Hands mark given for any mentioned O1 Fine tremor/CO2 retention Inspection: Face mark given for any two mentioned O1 Conjunctival pallor/Plethora/Central cyanosis/Oral candidiasis Cricosternal distance and tracheal deviation mark given for either O1 Palpation: Chest expansion O1 Palpation: Cervical and supra-clavicular lymph nodes O1 Palpation: Percusses and compares both sides O1 Palpation: Percuss into axillae O1 Auscultation: Auscultates both sides and compares O1 Auscultation: Auscultates axillae as well O1 Resonance: Tactical or vocal fremitus assessed O1 Resonance: Compares both sides O1 Summary: Summarise clinical findings O1 Data Interpretation Confirms patient details on CXR O1 Assesses technical details systemically: Rotation, Inspiration, O1 Penetration, Exposure (RIPE) Recognises right upper lobe consolidation O1 Question: What is the most likely diagnosis? O1 Pneumonia Question: How would this present on clinical examination? mark O1 given for either Reduced breath sounds; Bronchial breathing; Dull on percussion Clinical Reasoning Once the candidate has completed the data interpretation, please ask them the following 2 questions: O1 O1 Q1. How do you quantify the severity of community-acquired pneumonia? What criteria does it use? CURB-65 Confusion/Patient mental state; Urea; Respiratory rate; Blood pressure; O1 Patient age Q2. How would you manage a patient with moderate-severe pneumonia? 7-10 day course of Amoxicillin and Clarithromycin/Any macrolide (mark given for antibiotics) STATION NUMBER: 6 CLINICAL EXAMINATION, DATA INTERPRETATION & CLINICAL REASONINGPatient name: Sarah / Sam Finnigan CHI: 1908923546