Emergency · History + examination

Sudden facial droop, arm weakness and slurred speech - Emergency Department

HardYear 5 · Curtin style · 15 min + 2 min reading · 5 tasks

2 min reading · 15 min station · reminders at 2 min

Station - Instructions for candidate

You are an intern working in the Emergency Department of a metropolitan hospital in Perth with a CT scanner and a stroke service; the comprehensive stroke centre with clot retrieval is 20 minutes away. It is 9.20 am.

Wei Liu, 68, has just arrived by ambulance after his wife, Mei, saw the right side of his face droop and his right arm go weak while they were having breakfast. His speech is slurred. The paramedics have pre-notified a stroke call; the stroke registrar is on the way and a nurse is with you. Mei is at the bedside.

Your tasks are to:

  1. Take a focused history from Mr Liu and his wife.
  2. Perform a focused examination.
  3. Request any relevant investigations and interpret the results provided.
  4. State your working diagnosis and differential diagnoses to the examiner.
  5. Outline your immediate management plan to the examiner.
  • Assume the stroke registrar will be with you within 10 minutes; act as the doctor at the bedside until then.
  • Please verbalise your examination to the examiner; findings will be provided on request.

This is a 15-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you would examine or request, the way you would in the station. Nothing is named until you ask for it.

Whatever the examiner recognises is revealed below. Or pick a numbered item to reveal it blind.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.

After treatment

Once you have acted, ask how the patient has responded.