Station - Instructions for candidate
You are an intern in the Emergency Department at Geraldton Regional Hospital.
Colin Dwyer is a 79-year-old man brought to the Emergency Department by his daughter because he has been quiet, muddled and unsteady on his legs for two days. Blood test results are provided on the candidate sheet.
FBC and CRP
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 116 g/L | 130-180 g/L |
| White cell count | 18.4 x 10^9/L | 4.0-11.0 x 10^9/L |
| Neutrophils | 16.8 x 10^9/L | 2.0-7.5 x 10^9/L |
| C-reactive protein | 186 mg/L | <5 mg/L |
UEC and glucose
| Item | Value | Reference range |
|---|---|---|
| Sodium | 132 mmol/L | 135-145 mmol/L |
| Potassium | 4.8 mmol/L | 3.5-5.2 mmol/L |
| Urea | 18.2 mmol/L | 2.5-7.5 mmol/L |
| Creatinine | 168 umol/L | 60-110 umol/L |
| eGFR | 34 mL/min/1.73 m2 | >60 mL/min/1.73 m2 |
| Glucose | 13.8 mmol/L | 3.5-7.7 mmol/L |
Liver function and coagulation
| Item | Value | Reference range |
|---|---|---|
| Bilirubin | 92 umol/L | 3-20 umol/L |
| ALP | 486 U/L | 30-110 U/L |
| GGT | 612 U/L | 5-50 U/L |
| ALT | 178 U/L | 5-40 U/L |
| AST | 164 U/L | 5-40 U/L |
| Albumin | 29 g/L | 35-50 g/L |
| INR | 1.4 | 0.9-1.2 |
Venous lactate
| Item | Value | Reference range |
|---|---|---|
| Venous lactate | 4.1 mmol/L | 0.5-2.2 mmol/L |
Your tasks are to:
- Take a focused history from the patient and his daughter.
- 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.
- You are not required to request additional investigations beyond interpreting the provided blood tests.
- 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.