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 Clinical Station Practice Scenarios

Consider how you would approach each of the following scenarios.

Try to structure a succinct answer to each question.

Practice saying your answer out-loud or explaining it to a friend! 

Scenario 1:
You are the CT1 on call for orthopaedic surgery. You are called to see a 62- year-old patient who has become acutely short of breath. She is 5 days post-op from an elective left total hip replacement. 

Questions:

1. How would you assess this patient?

2. What are the possible differential diagnoses? (Name at least 5)

3. Name 3 investigations that you would perform to distinguish between these diagnoses and justify your choices.

4. Name an emergency presentation which this patient could have. 

ortho.jpg

Scenario 2:
You are the CT2 in ED.  A 19-year-old history student presents at 0200 complaining of a terrible headache which she claims started 6 hours ago and has not improved despite taking ibuprofen and co-codamol. When you take her into the consulting room, she asks if you could please dim the lights as they are irritating her eyes.

Questions:

1. How would you assess this patient?

2. What are the possible differential diagnoses? 

3. Name 3 investigations that you would perform to distinguish between these diagnoses and justify your decision.

4a. Name an emergency presentation that this patient could have. 

4b. Which out of hospital body would you potentially need to inform about this presentation?

headache.jpg

Scenario 3:
A 65-year-old gentleman presents to ED acutely complaining of back pain which he describes as currently being 10/10. He claims the pain started spontaneously 2 hours ago. The patient states that he is normally "fit and well". However, a quick review of his online notes reveals that he is known to suffer from T2DM, angina, HTN, glaucoma and OA. He was also diagnosed with a 4.0cm aortic aneurysm 6 years ago. His most recent hospital visit was 2 months ago after he slipped on his wet driveway. He was diagnosed with a stable L2 wedge fracture at this time and discharged with simple analgesia. 

Questions:

1. How would you assess this patient?

2. What are the possible differential diagnoses? 

3a) Name an emergency presentation that this patient could have. 

3b) Name 4 risk factors for this presentation.

3c) Explain the current screening programme for aortic aneurysms. Who is it offered to? What does the screening process entail? What are the guidelines for follow-up and treatment?

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*NB - these scenarios have been created for practice purposes. They may or may not resemble the scenarios that you encounter at interview.

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