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Compilation/organization of all LMCC materials from various sources
2004-2003
April 2004 LMCC
10 Minutes (7 stations and 1 rest)
1. 30 M presents with fall. Has bruise over L side of abdomen. In C-spine collar. Vitals stable. Manage for 1o or 2o survey. DPL shows free fluid in abdomen. Likely splenic rupture. Acute management. SURGERY
2. 40 M inferior STEMI. Presents with CP initially, then has CP in ER with inferior ST elevations. Treat medically and consider TNK. Question: if man wants to leave AMA, what do you do? Acute management. MEDICINE
3. 65 F with rectal CA does not want OR. Counsel her. Turns out her friend died with the same OR. Hx only (counselling /CLEO) SURGERY
4. 35 F pregnant (8 weeks) worried about risk of genetic defects. Counsel. She asks you whether its her right to have an abortion if she so chooses. Hx only (counselling / CLEO) OBS/GYN
5. 56 M presents with hemoptysis. On coumadin for A fib. Has long standing hemoptysis but now worse. Ex-smoker. No chest pain, no DVT risks. Hx and Px. Question: examiners asks what he would do if he is dissatisfied with care and wants to go to another physician. Hx and Px. MEDICINE
6. Mother is worried that her 3 ½ year old daughter who is still at home is not using complex sentences. Just using single words. Repeated otitis media. All other milestones okay and no social determinants / abuse identified on history. Brother who is 5 is okay. Mother concerned she is developmentally delayed. Question : what is your Dx (hearing loss). History only. PAEDS
7. 49 F with 3 weeks of depression. Not suicidal. Unable to sleep but wakes up in middle of night. About to be laid off from work, husband recently fired. Has older children at home. No abuse. No substance use. Question: what would you do treatment-wise (SSRI, refer to Psych) History only. PSYCH
5 Minutes + PEP (6 stations + 2 rest)
1. 40s man presents with abdominal pain and vomiting. One BM before this started, now not passing gas. Pain is colicky, in waves. No one ate with him at last meal. Prior appy. No IBD. Uncomfortable during history. History only. SURGERY
PEP: 1. Shows AXR with dilated SB loops and air-fluid levels. Interpret AXR
2. What is Dx (SBO)
3. How would you manage (NG, IV fluids)
4. If his pain worsens and his abdomen becomes peritoneal, and he becomes tachycardic what would you do (3 things): (IV fluids, antibiotics, gen surgery consult)
2. 60 male with claudication. Physical examination for PVD (upper and lower extremities). Px only. SURGERY
PEP: 1. ECG is normal. Ask you to interpret it.
2. What two investigations would you order for PVD (dopplers with ABI, angiography)
3. Five risk factors for PVD (Hypertension, diabetes, smoking, hypercholesterolemia, CAD, CVD, ESRD)
3. 30 M schizophrenic, acute dystonic reaction. On haldol for 5 days, previously on other agent. Not psychotic and not suicidal. History only. PSYCH
PEP: 1. What is the diagnosis (haldol induced dystonic reaction)
2. How would you treat it (benztropine 1-2 mg IM)
3. Mother calls you back after he leaves and says that he is trying to jump off the balcony. What do you do (tell her to call 911, issue a Form 1 which you can do as you had assessed him previously)
4. 40s man presents with elevated AS T (200) and ALT (200) (ALP 110, bili 26) on screening at time of insurance. Wants test repeated. 12 drinks on weekend. CAGE equivocal. Never drank more. IV heroin as teens. Is a janitor at a hospital. Had perinatal jaundice but nothing since. Previously healthy. Never transfused. No FMHx. History only. MEDICINE
PEP: 1. What is his diagnosis (acute hepatitis)
2. What are the three likely etiologies (HBV, HCV, alcohol)
3. What is your reporting responsibility at this time (none, but if HBV or HCV, must report to public health)
5. 27 F with 1 day Hx of LLQ abdominal pain. Physical exam only. Positive rebound, shake, guarding, cough tenderness. Rectal exam reveals L sided tenderness. On pelvic has IUD, L sided tendeness, cervical motion tenderness. No CVAT. OBS/GYN
PEP: 1. What are your 3 diagnoses (ectopic pregnancy, PID, ruptured ovarian cyst)
2. What 2 investigations would you do (abd/pelvic u/s, B HCG)
6. 2 ½ son has persistent cough after having URTI 3 weeks ago treated with amoxil and antitussives. Child had history of atopy. Wheezing. Cough worse at night. Wife smokes. Immunizations intact. No one else sick in family. Hx only. PAEDS
PEP: 1. What is your diagnosis (reactive airways)
2. What supports it on history (wheezing, atopy, worse at night)
3. 3 management options (bronchodilators, inhaled steroids, parents stop smoking).
7. 40 M presents with inability to weight bear on R hip. Has fevers, 1 day history of painful hip. No steroids. No trauma. No IVDU. No dysuria, STD risk factors. Likely septic hip. Hx and Px. MEDICINE
PEP: 1. What is the diagnosis?
2. How do you manage this?
LMCC Exam 2003 – Toronto
5 minute couplet
1. Physical exam for R sided chest pain
- do physical exam (chest)
- PEP: interpret x-ray: RML infiltrate
- PEP: prescribe antibiotic
- PEP: diagnosis – CAP and etiology: S. pneumoniae
2. L sided flank pain due to stone in ureter
- do physical exam (abdo) make sure you do rectal and genital exam and examine L flank
- PEP: interpret IVP; R sided filling defect
- PEP: initial treatment: IV fluids, pain control; antibiotics
- PEP: name 2 other investigations you would do
- PEP: pt was given septra with known drug allergy to septra; name 3 things you would do to rectify the problem
3. Pregnant 30 weeks with vag bleeding
- take history; some people were told she had pain; ? contractions vs. abruption
- PEP: likely diagnosis: most of us said bloody show vs. abruptio placentae
- PEP: would you do vag exam -> NO, do U/S first
- PEP: investigations you would do (I think list 2)
4. 15 y.o. with painful periods and missing school
- take history; it sounded like primary dysmennorhea
- PEP: likely DX: as above
- PEP: treatment: BCP
- PEP: can she make her own medical decisions: YES
5. 3 month old boy with + vomitting after feeding
- baby refeeds; normal pregnancy; now abuse
PEP: most likely diagnosis: most of us said GERD
PEP: interpret growth curves; weight crossed 2 curves and thus FTT
PEP: 2 management strategies other than meds: thickened feeds and elevation
PEP: if you suspected child abuse, what would you do: call CAS
6. Trauma station: young boy closed head injury
- do focussed neuro exam
PEP: very confusing: tests you would order
PEP: very confusing: actions you would take
10 minute
7. 30ish guy with + epigastric pain
- do physical and manage
- on questioning he has Etoh pancreatitis; he had it before
- at 9 min; girlfriend calls and wants to know what's going on
8. Young girl 24 with depression; counsel and take Hx
- father died about 1 year ago
- she was very depressed
- say you would have + followup
9. 50 woman POD 4 after fibroids removed
- she is now + crazy from ETOH withdrawal
- you are supposed to do MMSE but it was hard b/c she was crazy and agitated
- on hx find out she drinks 1 bottle a day
- at 9 min they ask you if she can go home; no way , she's nuts
10. Young boy with allergy to peanuts
- now stable but father wants counselling
- need to say epi pen, medical alert, now sharing snacks, school, teachers
11. Young woman PMH of bipolar on lithium x 10 years. She now wants to go off
- take hx and counsel
- make plans for f/u
- find out she was hospitalized twice
12. Old woman collapsed in mall: digoxin overdose; she is with grandaughter
- manage with nurse
- ECG shows block ??? give digibind
13. Smoking cessation
- take history and counsel
- woman wants to quit cold
14. Young guy with back pain;
- do physical
- he has very stiff movements
- at 9 mins they ask DX: anklyosing spondylitis
- they ask 3 associated features
LMCC II Oct 2003
Lithium counselling Psych
Smoking cessation Psych
Post op delirium / EtOH w/d Med
Peanut Allergy Peds
CHB Med
Pancreatitis / Epigastric Pain Surg
Young girl with Depression Psych
Back Pain Med
Trauma (Closed Head Injury) Surg
PEP: 2 Ix
2 Med Interventions
Pneumonia Med
Renal Colic / Pyelo Surg
VB with cramps, teenager, ethics OB GYN
3rd trimester bleed OB GYN
Vomiting / FTT Child Peds
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seeking study partner in USMLE, Canadian MCC OSCE examination
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