Surgery & perioperative · History + examination

Escalating leg pain after a fracture - Hospital ward

HardYear 5 · Curtin style · 10 min + 2 min reading · 4 tasks

2 min reading · 10 min station · reminders at 2 min

Station - Instructions for candidate

You are an intern on the orthopaedic ward of a Perth metropolitan hospital.

Vikram Iyer, a 42-year-old truck driver, presented to the Emergency Department at 11 am with a closed tibial shaft fracture sustained when a pallet fell on his leg at work. He was treated with a backslab and admitted for observation prior to planned surgery tomorrow. The ward nurse has called you at 5 pm because his pain is escalating rapidly despite analgesia and he is becoming increasingly distressed. You are to assess him now.

Your tasks are to:

  1. Take a focused history.
  2. Perform a focused examination.
  3. Summarise your findings to the examiner with your most likely diagnosis and differential diagnoses.
  4. Outline your immediate management plan to the examiner.
  • Please verbalise your examination to the examiner; findings will be provided on request.

This is a 10-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you would examine or request, the way you would in the station. Nothing is named until you ask for it.

Whatever the examiner recognises is revealed below. Or pick a numbered item to reveal it blind.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.