Station - Instructions for candidate
You are a final-year medical student in a general practice in Bunbury.
Hung Tran is a 68-year-old man attending a general practice in Bunbury with six weeks of progressively deepening yellowing of his eyes and skin. Blood tests are printed on the candidate sheet.
Liver function and coagulation tests
| Item | Value | Reference range |
|---|---|---|
| Total bilirubin | 186 umol/L | 3-20 umol/L |
| Conjugated bilirubin | 151 umol/L | 0-5 umol/L |
| Alkaline phosphatase | 642 U/L | 30-110 U/L |
| Gamma-glutamyl transferase | 811 U/L | 10-70 U/L |
| Alanine transaminase | 118 U/L | 5-40 U/L |
| Aspartate transaminase | 96 U/L | 5-40 U/L |
| Albumin | 31 g/L | 35-50 g/L |
| INR | 1.4 | 0.9-1.2 |
Full blood count and inflammatory markers
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 108 g/L | 130-175 g/L |
| White cell count | 9.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| Platelets | 398 x 10^9/L | 150-400 x 10^9/L |
| C-reactive protein | 18 mg/L | <5 mg/L |
Renal function and electrolytes
| Item | Value | Reference range |
|---|---|---|
| Sodium | 137 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Urea | 7.8 mmol/L | 2.5-8.0 mmol/L |
| Creatinine | 92 umol/L | 60-110 umol/L |
| eGFR | 71 mL/min/1.73 m2 | >90 mL/min/1.73 m2 |
Glycated haemoglobin
| Item | Value | Reference range |
|---|---|---|
| HbA1c | 63 mmol/mol | 20-41 mmol/mol |
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.
- You do not need to prescribe or write a prescription in this station.
- No imaging result is provided.
This is a 15-minute station, with 2 minutes of reading time.