2006, Hot Cases 1

The brief examiner's commentary for the clinical section this year was identical to the commentary for the previous year's second paper.  This supports the idea that it would be inefficient to write different comments for every paper, as the candidates make exactly the same mistakes every year. A less likely explanation for this duplication is the examiners' complete lack of interest in making any useful comments.


The Clinical Section: Hot cases

The Clinical Section (comprising 2 hot cases) was conducted at the Alfred Hospital, Melbourne.

Sixteen  out  of  twenty-seven  candidates  passed  the  combined  clinical  section  (seventeen  out  of twenty-seven passed the  hot cases overall, and nineteen out of twenty-seven passed the cold cases overall). 
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. Some  candidates  waste  valuable  time  at  the  start  of  the  case  by  spending  more  than  a  couple  of minutes  around  the  bedside  before  they  actually  commence  examining  the  patient.  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:
·  Sepsis, psoas abscess
·  Multiple trauma after a motor vehicle crash with long bone fractures and a ruptured bladder
·  End-stage liver disease, acute renal failure and shock
·  Lung abscess and bronchopleural fistula
·  Respiratory distress and Guillain-Barre Syndrome
·  Faecal peritonitis and multiple organ dysfunction
·  Pancreatitis and multiple organ dysfunction

Introductory questions included:
“This man presented with a gastrointestinal bleed. Can you work out why he may be jaundiced?”
“This elderly woman has been in Intensive care with abdominal sepsis. She is becoming difficult to wean off the ventilator. Can you assess her to try and elucidate why she is being difficult to wean?”
“This man has been in Intensive care for 8 weeks with an abdominal problem. Last night he spiked a temperature of 39°C. Can you examine him specifically to work out why he may have done so?”

Comments  documented  at  the  time  of  the  clinical  examination  suggested  that  common  problems encountered related to poor examination technique (eg. slow to actually start examining the patient), and poor discussion.

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