Luc Léger, 59 years old, presents to your office complaining of jaundice.
In the next 5 minutes, obtain a focused and relevant history.
At the next station, you will be asked to answer questions about this patient.
Examiner’s Checklist Fill in the bubble for each item completed satisfactorily |
| 1. |
|
Elicits onset/duration |
| 2. |
|
Elicits progression |
| 3. | Elicits associated symptoms | |
|
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- dark urine | |
|
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- pain | |
|
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- color of stool | |
|
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- fever | |
| 4. | Elicits risk factors | |
|
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- previous exposure to hepatitis | |
|
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- recent blood transfusion | |
|
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- intravenous drug use | |
|
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- foreign travel | |
| 5. |
|
Elicits an alcohol use history |
| 6. | Conducts a review of systems | |
|
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- skin | |
|
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- gastrointestinal | |
|
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- weight loss | |
|
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- change in appetite |
| If UNSATISFACTORY, please specify why: | |
|
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Inadequate medical knowledge and / or provided misinformation |
|
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Could not focus in on this patient's problem |
|
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Demonstrated poor communication and / or interpersonal skills |
|
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Actions taken may harm this patient |
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Actions taken may be imminently dangerous to this patient |
|
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Other: ________________________________________________ |
|
Did this candidate
demonstrate a lapse in professional behaviour? |
|
| |
Disrespectful to others (e.g., to patient, nurse) |
| |
Over-investigated / over-managed the patient |
| |
Actions raised ethical and / or legal concern |
| Briefly describe the behaviour for any of the above reasons or any other observed lapse : _______________________________________________________________________ | |
Q1. The abdominal examination of Luc Léger revealed no organ enlargement, no masses and no tenderness. What radiologic investigation would you first order to help discriminate the cause of the jaundice?
______________________________________________________Q2. If the investigations revealed that this patient likely had a post-hepatic obstruction, what are the two principal diagnostic considerations?
- ____________________________________________________
- ____________________________________________________
Q3. What radiologic procedure would you consider to elucidate the level and nature of the obstruction?
______________________________________________________Q4. If this patient were found to have a cancer localized to the ampulla of vater, what single treatment would you recommend?
_____________________________________________________
Answer Key |
||
|
Q1. |
The abdominal examination of Luc Léger revealed no organ enlargement, no masses and no tenderness. What radiologic investigation would you first order to help discriminate the cause of the jaundice? |
|
|
|
Score |
A1. |
Abdominal (liver) ultrasound |
4 |
|
Endoscopic retrograde cholangiopancreatography (ERCP) |
2 |
|
Maximum |
4 |
Q2. |
If the investigations revealed that this patient likely had a post-hepatic obstruction, what are the two principal diagnostic considerations? |
|
|
|
Score |
A2. |
Pancreatic (periampullary) cancer |
2 |
|
Choledocholithiasis |
2 |
|
Gallstones |
1 |
|
Maximum |
4 |
Q3. |
What radiologic procedure would you consider to elucidate the level and nature of the obstruction? |
|
|
|
Score |
A3. |
Endoscopic retrograde cholangiopancreatography (ERCP) |
4 |
|
Percutaneous trans-hepatic cholangiogram (PTC) |
4 |
|
Computed tomography (CT) scan |
1 |
|
Hida scan (biliary) |
0 |
|
Liver scan (Technetium 99M labeled sulphur colloid) |
0 |
|
Maximum |
4 |
|
||
Q4. |
If this patient were found to have a cancer localized to the ampulla of vater, what single treatment would you recommend? |
|
|
|
Score |
A4. |
Whipple procedure (pancreatic-duodenectomy) |
4 |
|
Biliary bypass |
2 |
|
Excision |
1 |
|
Chemotherapy |
0 |
|
Radiotherapy |
0 |
|
No treatment |
0 |
|
Maximum |
4 |