Professional Documents
Culture Documents
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.
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
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
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
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