Station - Instructions for candidate
You are a medical student on placement in the Emergency Department at Fiona Stanley Hospital.
Rosetta Fenech, a 52-year-old woman, has presented to the Emergency Department with three days of yellow eyes and itch after several months of intermittent right upper abdominal pain. The blood-test results are provided.
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 132 g/L | 115-155 g/L |
| White cell count | 8.4 x 10^9/L | 4.0-11.0 x 10^9/L |
| Platelets | 286 x 10^9/L | 150-400 x 10^9/L |
| CRP | 9 mg/L | <5 mg/L |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.1 mmol/L | 3.5-5.0 mmol/L |
| Urea | 5.8 mmol/L | 2.5-7.5 mmol/L |
| Creatinine | 71 umol/L | 45-90 umol/L |
| Total bilirubin | 86 umol/L | 3-20 umol/L |
| Conjugated bilirubin | 70 umol/L | 0-5 umol/L |
| ALP | 612 U/L | 30-110 U/L |
| GGT | 488 U/L | 5-40 U/L |
| ALT | 96 U/L | 5-35 U/L |
| AST | 78 U/L | 5-35 U/L |
| Albumin | 39 g/L | 35-50 g/L |
| Lipase | 42 U/L | 13-60 U/L |
| INR | 1.1 | 0.8-1.2 |
Your tasks are to:
- Take a focused history.
- Perform a focused examination.
- Interpret the blood-test results provided.
- State your most likely diagnosis and differential diagnoses to the examiner.
- Outline your initial management plan to the examiner.
- You do NOT need to summarise your findings to the examiner.
- Please verbalise your examination to the examiner; findings will be provided on request.
- Imaging can be requested; the examiner will provide a result if it is appropriate.
This is a 15-minute station, with 2 minutes of reading time.