ICE Survive Phase 2 Integrated Clinical Examination UNSW 2009 Assoc Prof Tony O’Sullivan St. George Clinical School

Integrated Clinical Examination The objectives of the ICE is to assess: –History taking and communication skills –Clinical examination –Clinical judgement & synthesis –Application of basic knowledge –Communication skills –Some basic management principles –Make sure you review the objectives in the student guide –Barrier examination

Integrated Clinical Examination - format 6 stations - mix from all four Phase 2 courses 20 minutes each station (bell at 10 & 18 minutes) One examiner per station (one case per student) Examiner interacts with student Grade given for 9 specific criteria Pass / fail is determined on an algorithm

Integrated Clinical Examination - format First 10 minutes: clinical component –History –Directed clinical examination –Summarise findings and discussion Second 10 minutes: viva component –Questions based on basic sciences, pathology, investigations, microbiology, theory from a case method tutorial etc –Some discussion may occur –Discussion on management will be on general principles not specific treatment

QUESTION SAMPLE 1 Clinical and Communication Section (10 minutes) Patient with inflammatory bowel disease. Age 25 – 70 yearsGender - either Parts of Phase 2 examined: HM Student Instructions This is Mr Smith. He is 65 years old and has a history of bowel problems. a. Please take a history of the patient’s gastrointestinal problems. This should include information about his past management and the medications he is taking. b.Please ask the patient about how their disease has impacted on them. c. Summarise the history to the examiner and provide a differential diagnosis of the gastrointestinal problem.

QUESTION SAMPLE 2 Clinical and Communication Section (10 minutes) Patient with chronic liver disease Age 25 – 70 yearsGender - either Parts of Phase 2 examined: HM Student Instructions This lady has been unwell for some time. Please look at her and examine what you think is appropriate. Patient with chronic liver disease hepatosplenomegaly (liver palpable, spleen palpable but not as easy), spider naevi, jaundice. Summarise your findings to the examiner and provide a differential diagnosis of the gastrointestinal problem.

VIVA SECTION SAMPLE 1: Pathology of metastatic adenocarcinoma of the bowel Biomedical and Social Science Viva Section (10 minutes) Parts of Phase 2 examined: HM & AE A 61 year-old man with a 23 year history of ulcerative colitis presents unwell with significant weight loss and anorexia. He has a history of non-compliance with his medication and previously he has been advised to undergo a colectomy. He had also noticed that he was becoming jaundiced, associated with pallor of his stools and darkening of his urine. He is noted to have an enlarged liver on examination which is non-tender. His LFTs are shown below.

VIVA SECTION SAMPLE 1: Pathology of metastatic adenocarcinoma of the bowel Question 1 Comment on the abnormalities present on the LFTS. Question 2 In view of the above clinical history, how would you interpret the biochemical abnormalities in this man’s liver function tests shown? Question 3 What further investigations might be helpful in determining the diagnosis in this case? What are the possible differential diagnoses? Question 4 Discuss with the examiner reasons why this patient may have been non- compliant with treatment.

QUESTION SAMPLE 3 Clinical and Communication Section (10 minutes) Patient with history of claudication and peripheral vascular disease. Age 50 – 80 yearsGender – either Parts of Phase 2 examined: S&H, HM Student Instructions This is Mrs Smith. She has a 6 month history of pain in her legs which comes on when she walks especially up hills. She has a 32 year history of smoking. Lately she has noticed pain in her right foot occurring at rest. a. Please examiner the patient’s lower limbs from a vascular point. b.Are there any dynamic movements that may help in the examination? c. Summarise your findings for the examiner and provide a differential diagnosis.

VIVA SECTION SAMPLE 2: Discussion on risk factors for atherosclerosis (10 minutes) Parts of Phase 2 examined: S&H, HM Instructions to student: Question 1. Describe to the examiner the possible risk factors which may predispose to atherosclerosis in an individual. Question 2. Describe how these risk factors can be diagnosed in asymptomatic patients? Question 3. Describe the metabolic syndrome (insulin resistance syndrome) and relate its components to CVS disease. Question 4. Discuss some strategies to reduce two components of the metabolic syndrome from a Public Health point of view.