Station - Instructions for candidate
You are an intern on placement in the Emergency Department at Bunbury Regional Hospital.
Giuseppe Rossi, a 76-year-old man, has walked into the Emergency Department at Bunbury Regional Hospital after vomiting approximately a cupful of fresh blood two hours ago. The bleeding has completely settled and he currently feels well, apart from a dull mid-back ache and low-grade fevers. He takes metoprolol, and the blood tests are provided.
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 88 | 130-180 g/L |
| Haematocrit | 0.27 | 0.40-0.54 L/L |
| White cell count | 14.8 | 4.0-11.0 x 10^9/L |
| Platelets | 280 | 150-400 x 10^9/L |
| CRP | 86 | <5 mg/L |
| Urea | 12.4 | 3.0-8.0 mmol/L |
| Creatinine | 105 | 60-110 umol/L |
| Lactate | 1.8 | 0.5-2.2 mmol/L |
| INR | 1.1 | 0.8-1.2 |
| APTT | 29 | 25-35 seconds |
| Bilirubin | 14 | <20 umol/L |
| ALT | 22 | 5-40 U/L |
| ALP | 108 | 30-110 U/L |
| Albumin | 36 | 35-50 g/L |
Your tasks are to:
- Take a focused history.
- Perform a focused examination.
- Interpret the blood test results provided.
- Summarise your findings to the examiner with your most likely diagnosis and differential diagnoses.
- Outline your initial management plan to the examiner.
- Please verbalise your examination to the examiner; findings will be provided on request.
- You do NOT need to perform an internal examination or any procedure.
- You do not need to write prescriptions.
This is a 15-minute station, with 2 minutes of reading time.