Time for the "talking" station! Quite worried about this as most people say that Asian candidate usually do not do as well as they would in clinical stations. I had 5 minutes to calm myself down before the question was given. Anxiously waiting there, I tried not to think about how bad I did in the CVS station.
Kringg!! I finally got the question and it was a bit different as compared to the case scenarios that I always practised.. Communication skill, ethics and a bit of history taking needed there. The case scenario is something like this:
"Mr X was admitted about several months ago for uncomplicated MI. Since then he, who has underlying Diabetes Mellitus, Hypertension and Hyperlipidaemia was under the cardiac protection programme. He was started on various medications (.... names of medications were listed including Aspirin).
Of late Mr X complains of shortness of breath and lethargy. He was seen by his GP who has taken his full blood count, Hb: 7.1g/dL, MCV low and MCHC low.
(.... the results of his last FBC when he was admitted in the hospital for uncomplicated MI was also given - Hb11.5g/dL).
Mr X is here to see you to discuss further regarding his problem.
Your task is to explain to his possible diagnosis and further assessment as well as address his concern"
Not the typical case scenario where they would give you a diagnosis/particular investigation/step of action up front and you need to disclose/discuss it etc..
I see that the question can be divided to several parts:
1. a little bit of history taking to confirm or exclude other diffential diagnosis
(my provisional diagnosis here is bleeding ulcer secondary to aspirin)
2. digging out his concern - in this case, his concern was malignancy
3. explaining to him what i think needs to be done to rule out/rule in the probable diagnoses (OGDS and colonoscopy) - briefly explain what it is and patient worried if it is suitable for him - just had MI
4. lastly explain to him plan of management
During the discussion with the examiners, it was about what I think is the diagnosis and my plan of management for it.
phew.. it went well! And now I'm starting to like the "talking" station.
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