Exam practice written by medical students
Questions with the reasoning after each one, and OSCE stations to run with a friend. Free, and written for Australian medical students.
Mock stations by discipline
One station, three people
You are a junior doctor in the emergency department. Your next patient is Achol Deng, 44, presenting with a sudden severe headache.
- Take a focused history
- Outline to the examiner:
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
“It was like someone hit me with a bat. Worst headache of my life. It's easing now, though.”
Eyes half closed against the light, hand on the back of your neck.
- Onset to peak in seconds; during exertion; exact time2
- Worst ever; compared with past headaches1
- Vomiting, neck stiffness, light; blackout, focal symptoms; injury, fever, rash1
- Smoking, BP, blood thinners; mother's brain bleed1
You're the candidate. Open this for your instructions; I've got the script and the checklist.
Sent
Try one
A 42-year-old farmer attends because his wife insisted. She left him four months ago and he has been drinking a bottle of wine most nights. He has lost 6 kg, wakes at 4 am, and has stopped going to the football club. He says that until last week he felt hopeless, but he now feels "calm, like a weight has lifted", because he has "made a decision" and everything is "sorted". On gentle questioning he reveals that he has written letters to his children, given his working dog to a neighbour, and knows exactly which paddock and which of his rifles he would use. He does not want treatment and asks you not to tell his wife. He has no psychotic symptoms.
Which one of the following is the most appropriate management?