AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
LMCC Scenarios 2002
5 minute stations
1. 30 M presents with cough, sputum, pleuritic chest pain. Do physical exam.
PEP: (1) Interpret CXR (RML infiltrate)
(2) What is the diagnosis (CAP)
(3) What is the most likely pathogen (S. pneumoniae)
2. 40s female presents with shooting leg pains when she flexes her neck. Also has fleeting visual symptoms and urinary retention. FMHx of MS. History only.
PEP: (1) Diagnosis (MS)
3. Mother brings in 3 month old child c/o regurgitation after every meal. Shows you copies of growth curves which show that child is <5 %ile and has fallen 3 curves. Mother depressed and overwhelmed. Denies projectile vomiting and varies on abuse RF. History and counsel.
PEP: (1) What is your diagnosis (r/o pyloric stenosis)
(2) What is your management plan (referral to surgeon for further investigations)
(3) What are 4 risk factors for abuse in this child – out of the blue question: (only child, first child, young mother, possible mood disorder in mother . . .)
4. 60s man presents with acute urinary retention. History only.
PEP: (1) Physical examination shows an enlarged prostate. Next step in management?
5. 50s man presents with acute flank pain. Physical exam only. Physical exam shows CVAT.
PEP: Interpret IVP (shows unilateral hydroureter and stone at PU jxn)
6. 60s man p/w hematemesis. Physical examination.
PEP: Diagnostic possibilities, management
7. 20 M schizophrenia p/w acute onset neck pain. Recent change in meds from risperidone to haldol. Likely acute dystonia. History.
PEP: Diagnosis, acute management
8. Rest
10 minute stations
1. Suicidal girl
2. Pregnant lady elective C-section
3. Management of acute MI
4. Hemolytic transfusion reaction / error
5. LBP
6. Kid with Diabetes
LMCC Exam II: 2002
10 Minute Stations
1. 28yo female counseling re: C-section (take a gyne hx)
2. 40 yo male given wrong ABO group. Manage pt. (make sure you say you would call the blood bank right away and tell them about mistake! Obviously this patient's blood is going to another person and could cause a transfusion reaction)
3. 50yo female wants HRT. Counsel. (ask about risk factors)
4. 50yo male with acute urinary retention. Manage
5. 29yo male with low back pain. Take history and do physical.
6. 40yo male with chest pain. Take hx and manage.
5 Minute Stations
1. 20yo with stiff neck. Take a history. (acute dystonic reaction)
2. 8 month old male with vomiting hx. Take a history.(just switched formulas)
a. Post-encounter probe: identify risk factors for child abuse
3. 20 yo male with R sided pain. Unwell with fever. Do a physical exam. Look at CXR (pneumonia)
4. 20yo male with abdominal pain. Take history and physical.
a. Post-encounter probe: Differential Diagnosis
5. 35 yo male with abdominal pain. Given IVP identify the problem. (stones).
Post-encounter probe: Management of this patient
LMCC II October 2001
10 minute stations:
1) Young f feeling overwhelmed, young children at home. No medical problems, not on any meds, not suicidal. 4 yr history of feeling down and low energy. Not overtly depressed. Likely dysthymic. Asks you, "Am I crazy?" Wants reassurance and to know whether you can help her. History only.
2) 70 yo f brought in after collapsing in a shopping mall. Unresponsive, GCS around 8. List of medications in purse given to you when you ask for meds, includes dig and spironolactone. Give orders to nurse and manage in ER setting. EKG shows complete heart block, HR 40. Pressure about 70 systolic. Give her atropine 0.5 and HR comes up to 70. No problems with fluid bolus. She also has a living will in her purse that says she doesn't want to be resuscitated, so you shouldn't intubate her early (her sats are fine and there is no blood work back yet, including a dig level). At nine minutes, the examiner asks you what you would do considering the will if in front of you the EKG degenerates into VF. You never get a serum dig level back so I didn't give digibind, but I treated this like a presumed dig toxicity exacerbated by hypokalemia. The document is from a lawyer so I presume they want us to do nothing.
3) 60 yo m, lawyer, on coumadin for afib, presents w hemoptysis of 1 tbsp, very worried. Take a history and appropriate physical. O/E: no findings. He turnes out to be a smoker. Hasn't had any bleeding. INR has not been checked in one month and he is getting coumadin from family doctor, dose between 5 and 7. No constitutional symptoms. At nine minutes: examiner asks you what you do when the next day the patient calls saying he is unhappy with the care you have given him and wants a copy of his chart.
4) Foster mother of 10 month old child she has taken care of for four months. She is complaining the baby has had 8 weeks diarrhea. Relevant hx. No medical hx available on the baby. On questioning, you find out they have been giving the baby all kinds of weird stuff including adult food, and she had some diarrhea with milk and juice. No other symptoms. At nine minutes, you are asked for two potential diagnoses, and what you would do if the baby's mother called that afternoon and asked for information on the baby's condition. I said this could be toddler's diarrhea and lactose intolerance, but I think I would have been better to say what I found on my questioning, that the diet is too advanced for the baby.
5) 30 yo m at home with wife, started to have severe nausea and vomiting, she called ambulance. EKG normal. Epigastric pain, Might have been slightly hypotensive. Manage and give orders to nurse. ABC, etc etc. On questioning you find out he drinks lots of EtOH and had pancreatitis in the past. No suggestion this is cardiac. He is in a lot of pain and simulating epigastric tenderness. I gave him some Demerol, kept him NPO, etc etc. At nine minutes: pt's wife is on the phone asking for information. Ask the patient and he says, "She'll nag me about my drinking, tell her I have the flu". You have to respond to this.
6) 30 yo f previous C-section for true knot in cord. 10 wks pregnant, here to talk to you about delivery options. You are given her delivery report out in the hall. There were no probs with the birth and the C-section was unanticipated. Basically, she is irritated and upset because she couldn't have a vag delivery, and asks you to guarantee her a vag delivery this time. Also wants to try to have the baby at home and wants you to tell her this is ok. VBAC counselling, warning her about risks associated with home deliveries for VBAC (?), etc. At nine minutes, what would you do if patient asks for a copy of the chart? What do you do if she refuses to give it back?
7) 60 yo f presents bc radiation leaking into house and Russians are after her. You are asked to assess her to see if she is competent for treatment. Not suicidal or homicidal. Fulfills some criteria for schizophrenia. No time or paper in room to do a Folstein. Says she will consent to a treatment if it can make the tingling in her arms stop (which she says is from radiation). Stupid station.
8) Rest station (I aced this one.)
5 minute couplets:
1) 60 yo m came to MD a few days ago NFW. Your office partner did a CBC; MCV 120, anemic, low WBC, low plts. Take a relevant hx. O/E: Peripheral neuropathy, probs walking at night. Tingling. Some mental symptoms. No consitutional illnesses as far as I can remember. No ETOH. Written: give most likely dx, give 2 other possibilities for the neuropathy (I said peripheral neuropathy 2ndary to lymphoma, gastric, causing b12 deficiency, or DM). Give 2 tests you want. Pt tells you he is a bus driver and he has forgotten to make 2 pickups this week. How do you counsel him?
2) 20 f w abdo pain. Do a physical exam. o/e: she has profound tenderness in RLQ, won't straighten legs no matter how often you ask her. written: What are 5 things you want to know, three most likely diagnoses...and if she is diagnosed with chylamidia, what are 2 responsibilities you have to public health?
3) 40ish man w severe abdo pain x 24 hours. Relevant history. o/e: hx of appendectomy. No relevant hx otherwise. Last BM 24 hours ago. WRITTEN: give three findings, + or -, on abdo films (he has dilated SB, multiple air fluid levels, no free air). List three things in management. When, if ever, would you consider consulting general surgery?
4) Telephone call: you are doc in ER in remote community and a mother has phoned telling nurse she will only speak to MD. o/e: get her number and address right away. Kid was playing in grandmother's room and took some BP meds, no idea what kind, mother threw bottle out, quanitity unclear. Kid crying. Keeps asking you what to do, frantic. Mother gets scripts filled at a pharmacy in Ilderton. You need to calm her down, find out where she is, send ambulance. WRITTEN: List five things you would do when the child arrived in ER. What are three things you would monitor specifically as they pertain to poisoning? (or something like that). You find out a similar incident happened with the kid's sibling. Who do you call? What is you responsibility? What do you tell the mother?
5) 70 yo f w h/ache. Take hx. o/e: jaw s/s and R visual changes. No afib or other hx. No other findings on hx. WRITTEN: most likely dx. What are three tests you would order to confirm? What is the major complication of this dx? List your management in general terms.
6) 65ish man w leg pain. Peripheral vascular exam. WRITTEN: What are three tests you would order? I forget the rest of this one; sorry.
7) Young first time mother complaining baby crying a lot. Take a hx. o/e: Baby crying about three hours a day more than three times/week = colic. Hasn't tried usual stuff to comfort colicky baby. Father not home much. Baby passing gas after eating. WRITTEN: What is your dx? What test, if any, do you want to order? Outline your management of this pt. What are three factors that would put this child at risk of abuse? (This came out of nowhere for all of us; I said female child, young mother, first baby, mother overwhelmed, or something like that.) You also get the baby's growth charts, and she is in the 50th %ile.
8) Rest station - Think of one good reason you should have paid 1000 bucks to write this dumb piece of crap.
LMCC October 2001 (alternative descriptions)
5 minute couplet stations
1. 40 yo male with 24 hr history of periumbilical abdominal pain. Pt is febrile. Take a history. (small bowel obstruction)
PEP: - 3 views of abdo xrays-list 3 negative or positive findings on exam
- lab results given - give diagnosis
-give 3 treatments you would do in E.R.
-when would you consider surgical intervention
2. 29 yo female with 2-3 day history of lower abdo pain. Perform a focused and pertinent physical exam. Vitals - pt febrile, tachycardic. Abdo exam- guardiing, rigidity, peritoneal signs, severe pain in LLQ. Do rectal exam - negative. Do gyne exam - must ask specifically about speculum exam, appearance of cervix and os and any discharge. Ask about bimanual palpation- cervical tenderness, adnexal tenderness, any masses.
PEP: - What 5 things on history would help determine diagnosis.
- What are the 3 most likely diagnosis.
- Told that chlamydia grown on culture -What is your obligation to public health concerning this issue (3)
3. 81yo male returns to your office for follow up for results of bloodwork after previous complaint of symptoms of dizziness, lightheadedness and ataxia. Blood work shows macrocytic anemia. Take an appropriate history.
PEP: - What is most likely diagnosis.
- What other diagnosis could account for neurologic symptoms.
- What 2 investigations would help confirm diagnosis
- The pt is a school bus driver. The other day he forgot to pick up 2 stops. The patient still wants to continue driving. What advice would you give.
4. 81yo female with complaint of severe headache. Take a focused history.
PEP: - What is most likely diagnosis- temporal arteritis
- What 2 things on history confirms the diagnosis
- What is the most common complication of this condition
- What investigations would you order to confirm diagnosis (3)
- How would you manage this patient
5. 50 yo male with hx of peripheral vascular disease. Do a focused physical exam.
PEP: - What 5 things on history would be important to know
- What 2 investigations would you order for this diagnosis
6. Young mother brings in 4 mos old infant for crying and iritability for few weeks. Nurse is weighing infant currently. Take a focused and relevant history from mother. (Looking for child abuse)
PEP: - What is the most likely diagnosis.
- What one investigation (if any) would you order.
- List 4 things on family history that would make you suspect child abuse.
7 Hysterical mother on the phone whose child took prescription medication. Mother will only talk to doctor on call. Take a focused history.
PEP: - How would you manage this patient when they arrived in E.R.
- This has happened to a previous child at home last year. You suspect child neglect and will inform CAS. What would you tell the mother.
10 minute stations
1 Elderly woman fell down at shopping mall. Pt in E.R., vitals given. Nurse in room with you. Assess and manage patient
- make sure you know Glasgow coma scale, ask about meds (? digoxin toxicity), ask about advanced directives. ECG shown to you and you are asked to read it (I think it was a 3rd degree heart block)
At nine minutes evaluator asks: Given the advanced directive, how would you further manage this pt? What would you do?-make sure you tell them that you would give supportive measures i.e. pain control and that you would write a DNR order.
2 35 yo female comes to your office with complaint of lethargy and decreased interest in activities. Take an appropriate history and address any concerns the pt may have.
-the pt will ask you in the middle of the interview if there is something that can be done about her condition.
3 60yo female is in your office stating that radiation is leaking into her house. Take a focused history and physical to assess her competence for medical management.
4 35yo male construction worker comes to emergency for a 4 day history of epigastric pain. Assess and manage the patient. A nurse is in the room to give instructions to.
5 50 yo male comes to your office for a 24hr history of hemoptysis. Take a focused history and physical exam. At nine minutes evaluator asks question ???
6 The foster mother of a 10 month old infant has brought her baby in for diarrhea. The infant is with the nurse being weighed. Take a focused and relevant history from the foster mother.
At nine minutes evaluator asks: What are your possible diagnosis for the diarrhea
7 A 35yo female who is 10 weeks pregnant comes to your office to discuss her options for labor and delivery of this current pregnancy. Pt was pregnant last year which resulted in an emergency C-section. The discharge summary is provided.
At nine minutes evaluator asks: What will you tell the patient if she asks to see the discharge summary? What will you tell her if she says that she wants to take that copy with her?
2000 MCCQE II questions
10 minute stations
1. Peanut Allergy in child: counsel
2. Acute MI: manage with help of nurse
3. Fall from ladder: manage with help of nurse
4. Woman with “nerves in stomach” and normal investigations from gastroenterologist and internist: history
5. Preeclampsia: counsel
6. Man with headache: would like prescription for fiorinal
7. Back pain, radiating down leg: history and physical
5 + 5 Stations
1. Neonatal Jaundice history and questions about causes and tests
2. HIV patient with SOB: examine and CXR
3. Crohn’s patient with RLQ pain: examine and AXR
4. Primary nocturnal enuresis in a 9 year old: history and causes
5. Leg Pain: history and causes
6. Amenorrhea: history and causes
7. Seizure management over phone: history
Hot off the Press! 1999 LMCC part II exam questions.
10 minute stations
1. Man in 20's fell off ladder 14 feet. Bruised over left anterior ribs. On table in c-collar. Asking for pain relief. Manage.
2. Woman in 60's discharged 4 days ago from hospital with PE. Was on 5 mg of coumadin OD, discharged with INR of 2.0. INR today 1.0. Counsel and manage.
3. 10 year old child with frequent URI’s, in today with one. Physical exam and address parent’s concerns.
4. Female 63 years old 4 days post GI surgery with 15 minutes of SOB. Physical exam.
5. 16 year old female in office because her mother is concerned about her vomiting. History.
6. Immigrant woman who has 6 week old baby. Her friends have told her that he needs “shots”. Her mother has told her that the shots harm the baby. Counsel.
7. Woman in ?50's c/o numerous aches and pains. History and management. Give diagnosis.
5 minute stations (A patient encounter; B written station)
1. A. 26 year old male refused life insurance because of elevated LFT’s. Focussed history.
B. Ddx, other tests would order.
2. Forty-two year old executive/lawyer? with heavy bleeding per vaginum. Focussed history.
B. Ddx, testing
3. Woman thirties with infertility, couple trying to get pregnant 18 months. Husband couldn’t be there because of sudden business trip.
B. Ddx, testing
4. Young male, thrown 20 feet from bike by car, in ER. Neuro exam.
B: interpret and comment on c-spine film
5. HIV patient with increasing exercise intolerance and dyspnea, now dyspneic at rest. Physical exam.
B: interpret CXRay, Ddx, Rx
6. Visit mother who has given birth 6 hours earlier to a full term baby weighing less than 5 lbs. Focussed history.
B. Ddx. ?, ?
7. Construction worker with shoulder pain. Physical exam R shoulder. B. interpret xray, Ddx,Rx
PART I
COUPLETS (5MIN. + 5 MIN.)
1. TAKE HX. FROM MAN WITH ACUTE URINARY RETENTION.
PEP: MOST LIKELY DX, DDX, INVESTIGATIONS
2. TAKE HX. FROM MOM OF CHILD WITH FEBRILE SEIZURE
PEP: DX, TELL MOM RISK OF RECURRENCE, TELL MOM HOW TO MANAGE A FUTURE SEIZURE
3. TAKE HX. FROM MAN WITH DYSPHAGIA
PEP: SHOWN BARIUM SWALLOW, DESCRIBE XRAY FINDING, GIVE DX, GIVE WORKUP
4. EXAMINE YOUNG MAN WITH ACUTE HIP PAIN
PEP: DDX, KEY HX POINTS, INVESTIGATION
5. EXAMINE YOUNG WOMAN WITH PURPURA AND EPISTAXIS
PEP: HX, DX, INVESTIGATIONS
6. EXAMINE 20 Y.O FEMALE WITH HYPERTENSION
PEP: DDX, INVESTIGATIONS, WHAT TO DO IF YOUR INVESTIGATIONS ARE NORMAL
10 MIN. STATIONS
1. COUNSEL YOUNG WOMAN WITH UNWANTED PREGNANCY (MOSTLY RE: ABORTION)
2. HEAD TO TOE NEURO EXAM FOR A CONFUSED LADY ALREADY SEEN BY ANOTHER MD
3. COUNSEL YOUNG WOMAN RE: ORAL CONTRACEPTIVE PILL
4. MANAGE AN EPIGASTRIC STABBING IN ER WITH A NURSE
5. WOMAN WITH "ABDOMINAL BLOCKAGE" SEEN AND CLEARED BY ANOTHER MD
Q1-DESCRIBE PT'S APPEARANCE WITHOUT LOOKING, Q2-DX
6. TAKE HX FROM WOMAN WITH SLEEP DISTURBANCE
Q1- DX, Q2- MANAGEMENT
PART II
COUPLETS (5MIN. + 5 MIN.)
1. TAKE HISTORY FROM MOTHER OF CHILD WITH CHRONIC COUGH UNRESPONSIVE TO ABX
PEP DX, KEY HX. ELEMENTS, INVESTIGATIONS
2. EXAMINE YOUNG WOMAN WITH LLQ PAIN
PEP: DDX, KEY HX. ELEMENTS, INVESTIGATIONS
3. TAKE HX. FROM WOMAN WITH MENORRHAGIA
PEP: DDX, KEY HX ELEMENTS, INVESTIGATIONS
4. EXAMINE MAN WITH CALF CLAUDICATION
PEP: INTERPRET EKG, RISK FACTORS, INVESTIGATIONS
5. TAKE HISTORY FROM MAN WITH SOB AND SPUTUM
PEP: ER RX, INVESTIGATIONS, ADVICE RE: PREVENTION
10 MIN. STATIONS
1. MAN WITH ANKLE SPRAIN. COUNSEL RE: REHAB, CARE, FOLLOW-UP
2. MANAGE ACUTE MI IN ER WITH NURSE
3. TAKE HX. FROM PARENT OF CHILD WITH LANGUAGE DELAY
Q1-DX
4. EXAMINE MAN WITH LOW BACK PAIN
Q1- DX (DISK PROLAPSE) Q2- WHAT LEVEL
5. TAKE HISTORY AND COUNSEL A MAN WITH IMPOTENCE.
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| equinoxe
Topics: 15
Posts: 78
|
what is LMCC please? how are these cases relevant for CS?
___________________
waiting gives the devil time
|
|
| |
| | |
