Station - Instructions for candidate
You are a final-year medical student on placement in the Emergency Department at Fiona Stanley Hospital.
Achol Mading is a 46-year-old woman brought to the Emergency Department after a night of heavy drinking. She has had four episodes of forceful retching followed by two mouthfuls of fresh red blood. A triage handover and blood test results are provided.
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 92 g/L | 115-155 g/L |
| Platelets | 88 x 10^9/L | 150-400 x 10^9/L |
| White cell count | 10.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| INR | 1.5 | 0.9-1.2 |
| Prothrombin time | 17 seconds | 10-14 seconds |
| Activated partial thromboplastin time | 34 seconds | 25-35 seconds |
| Fibrinogen | 2.1 g/L | 2.0-4.0 g/L |
| Bilirubin | 34 umol/L | 3-20 umol/L |
| Albumin | 28 g/L | 35-50 g/L |
| ALT | 68 U/L | 5-35 U/L |
| AST | 142 U/L | 5-35 U/L |
| ALP | 156 U/L | 30-110 U/L |
| GGT | 310 U/L | 5-40 U/L |
| Urea | 12.8 mmol/L | 2.5-7.8 mmol/L |
| Creatinine | 78 umol/L | 45-90 umol/L |
| Sodium | 134 mmol/L | 135-145 mmol/L |
| Potassium | 3.7 mmol/L | 3.5-5.2 mmol/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.
- You do NOT need to obtain consent for a procedure today.
- You do not need to write prescriptions.
- 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.