Station - Instructions for candidate
You are a final-year medical student working with a GP in a suburban Perth practice. The GP has asked you to see Mr Akol with the results of the tests ordered last week.
Abraham Akol, 52, has come back for the results of the blood tests and the ultrasound his GP ordered a week ago. The results are printed below; he has not seen them. He is still jaundiced and still itching.
Liver function tests, coagulation and viral hepatitis serology (taken 6 days ago)
| Item | Value | Reference range |
|---|---|---|
| Bilirubin (total) | 140 micromol/L | <20 micromol/L |
| Bilirubin (conjugated) | 110 micromol/L | <5 micromol/L |
| Alkaline phosphatase (ALP) | 480 units/L | 30-110 units/L |
| Gamma-glutamyl transferase (GGT) | 620 units/L | <60 units/L |
| Alanine aminotransferase (ALT) | 95 units/L | <40 units/L |
| Aspartate aminotransferase (AST) | 70 units/L | <40 units/L |
| Albumin | 38 g/L | 35-50 g/L |
| Total protein | 72 g/L | 60-80 g/L |
| INR | 1.1 | 0.9-1.2 |
| Hepatitis A IgM | Negative | Negative |
| Hepatitis B surface antigen | Negative | Negative |
| Hepatitis B core antibody (total) | Negative | Negative |
| Hepatitis B surface antibody | 180 IU/L | <10 IU/L (unvaccinated) |
| Hepatitis C antibody | Negative | Negative |
Abdominal ultrasound and full blood count
| Item | Value | Reference range |
|---|---|---|
| Liver | Normal size (14 cm) and echotexture; no focal lesion | Normal |
| Bile ducts | Common bile duct 4 mm; no dilatation of the ducts within the liver | CBD <6 mm |
| Gallbladder | No stones; wall 2 mm; no pericholecystic fluid | Normal |
| Pancreas and spleen | Pancreas visualised, normal; spleen 10 cm; no ascites | Normal |
| Haemoglobin | 142 g/L | 130-180 g/L |
| White cell count | 7.8 x10^9/L | 4.0-11.0 x10^9/L |
| Eosinophils | 0.7 x10^9/L | <0.5 x10^9/L |
| Platelets | 260 x10^9/L | 150-400 x10^9/L |
| MCV | 89 fL | 80-100 fL |
| Lipase | 35 units/L | <60 units/L |
Your tasks are to:
- Take a focused history from Mr Akol.
- Interpret the results provided.
- Explain what the results show and your provisional diagnosis to Mr Akol.
- Discuss your initial management with Mr Akol.
- You do not need to examine Mr Akol.
- The results are printed on this sheet; Mr Akol has not seen them.
- Further results are available from the examiner on request.
This is a 15-minute station, with 2 minutes of reading time.