CENTRE FOR INTERNATIONAL MEDICAL GRADUATES

CLINICAL PREPARATION COURSE

Station 6M9
CANDIDATE INFORMATION
You are a general practitioner working in a suburban group
practice.
Mr. Stefan Giordano is a 59 year old man who has presented to
your office as a new patient.
He is complaining of a cough.

Your task is to:

Perform a focused history and examination of the presenting
complaint.
Explain the probable cause of the tiredness and discuss
management with the patient.

Centre for International Medical Graduates

CENTRE FOR INTERNATIONAL MEDICAL GRADUATES

CLINICAL PREPARATION COURSE

Station 6M9
PATIENT INFORMATION
You are Mr Stefan Giorando a 59 year old man who has come to see the GP
because you are worried about your cough.
Details of the coughing:
- You have had a nagging dry cough for the last few months which
sometimes keeps you awake at night
- The irritating cough started after a cold all the other symptoms of
runny nose, sore throat and fever went away but the cough persisted
- You previously used to only cough in the mornings when you usually
bring up a small amount of brownish sputum you have had the
morning cough for many years and have always thought it was just a
smokers cough
- The last 2 mornings worried you as you noticed flecks of bright red
blood in the sputum on the tissues this has never happened before
- You havent noticed any weight loss and have always been thin
- You get short of breath only when you walk up stairs you dont do
any regular exercise in fact walking up stairs is the most exertion
you have done in a long time
- You are secretly worried about lung cancer (only admit this if the
doctor mentions lung cancer at some time in the consultation)
- No chest pain
- No leg pains or swelling
- No recent immobilisation, surgery or previous blood clots
Past medical history
- Bronchitis most winters for the last 5 years
Medications
Nil
Social
- Heavy smoker since teenage years at least 1 packet a day
- No regular alcohol
- You live with your wife you have 1 child who is married and lives in
the next suburb to you
- You work as a conductor on the railways
Centre for International Medical Graduates

CENTRE FOR INTERNATIONAL MEDICAL GRADUATES

CLINICAL PREPARATION COURSE

Station 6M9
FHx
- Father is 79 and in good health is only troubled by arthritis
- Mother is 70 and also in good health
Key examination findings:
HR 74 reg BP115/75 RR18 SaO2 94% R/A
Thin; No distress at rest; no clubbing; no lymphadenopathy
ENT NAD
Chest clear
Abdomen normal CNS grossly intact

Centre for International Medical Graduates

CENTRE FOR INTERNATIONAL MEDICAL GRADUATES

CLINICAL PREPARATION COURSE

Station 6M9
EXAMINER INFORMATION
59 year old man with probable lung cancer
- history of new cough and haemoptysis in a heavy smoker with no
acute infective symptoms
Aims for Candidate
- Mainly an exercise in taking a thorough and appropriate history and
being able to explain the likely condition in simple terms
- Identify the high probability of a malignancy
- Be able to explain your concerns to the patient in a sensitive manner
- Be able to organise urgent appropriate investigation (including FBC,
coagulation profile, CXR, sputum for m/c/s and cytology, CT chest)
- Be able to organise urgent referral to a physician for further
management including possible bronchoscopy
CRITICAL ERRORS
-

Not identifying that a malignancy must be urgently excluded

Not organising appropriate timely investigations
Not organising urgent referral to a physician
Failure to explain the likely problem to the patient in simple terms
with a sensitive manner

Centre for International Medical Graduates