2005, Hot Cases 1

The comments written by the examiners in regards to this clinical section were clearly a masterpiece of helpful feedback. They were so good that the college reused them, copying the comments almost verbatim in the next three papers.

The Clinical Section: Hot cases
The  Clinical  Section  (hot  cases)  was  conducted  at  the  St  George  Hospital,  and  Prince  of  Wales Hospital, Sydney.
Fourteen out of twenty-two candidates passed this combined section. 
Candidates  should  listen  carefully  to  the  introduction  given  by  the  examiners  and  direct  their examination  accordingly.    Patients  were  usually  presented  as  problem  solving  exercises.    For maximal marks, candidates should demonstrate a systematic approach to examination, clinical signs should  be  demonstrated,  and  a  reasonable  discussion  regarding  their  findings  should  follow.    The twenty minutes available for each case provides ample opportunity to discuss related investigations and plans of management.
Exposing the patients should be limited to those areas that are necessary for that component of the examination, and in keeping with the modesty requirements of the patients. Candidates must show appropriate courtesy and respect to patients.

Cases encountered as hot cases included patients with:
·  Cardiogenic  shock  after  cardiac  surgery  (introduced  as  “presented  with  cardiogenic  shock. Subsequently suffered a cardiac arrest.  After resuscitation he had urgent angiography which showed  severe  triple  vessel  disease.    Then  had  urgent  coronary  artery  grafting.  This  was now 5 days ago.  Please can you assess with a particular focus on suitability for weaning.”)

·  Oliguria  after  prolonged  abdominal  surgery  (introduced  as  “could  you  please  examine, particularly in regards to diagnosis/management of oliguria”)

·  Multiple trauma (introduced as problem is increased ICP. Can you please examine patient in relation to increased ICP”)

·  Febrile  after  surgery  (introduced  as  “in  ICU  after  complications  post-elective  surgery. Febrile overnight; please examine for a cause.”)

·  Respiratory failure and AML (introduced as “respiratory failure for 5 days. Please examine for causes and status of respiratory failure”).

·  Spinal  injury  (introduced  “prolonged  ICU  stay  after  being  injured  in  an  accident.  Please examine neurological state”)

Comments documented at the time of the clinical examination suggested that common problems encountered  related  to  examination  technique  (eg.  erratic/disorganised),  detection  and interpretation of clinical signs, and identification of clinically significant issues.

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