Some Drills On Station 5 (Part 1)

More often than not, candidates would go into a sudden lapse of thought block when they are presented a patient at station 5. Knowing that you'd need to come up with a diagnosis in a very short time, the adrenaline surge and tachycardia invariably complicate the whole picture!

The only way to secure a good chance of passing station 5 is to do a lot a lot a lot of cases.

Since station 5 is a spot diagnosis station. As mention by eMRCPian before, the 'hit-hard' strategy is the strategy of choice. Even though you do not want to commit yourself to a diagnosis, you must be able to come up with a reasonable differential diagnoses within the 1st minute of presentation!

Let's ride!

Stem: Look at this patient's face and tell me what you think.

Suggested presentation:

This patient has herpes zoster ophthalmicus as evidenced by an area of confluent erythematous papules and vesicles, some of which are crusted. The area affected coincides with the region served by the ophthalmic branch of the trigeminal nerve and hence the diagnosis. I would end my examination by looking closely for any corneal involvement and preferably under a slit-lamp.

Q: What is the early sign would you look for in ophthalmic herpes?
A: I would look hard for the presence of Hutchinson's sign.

Q: Why would it be important to look for this sign?
A: Ophthalmic herpes could be sight-threatening if left untreated. Hutchinson's sign is one of the early signs of eye involvement.

Q: How would you treat this patient?
A: A full 7-10 day course of oral acyclovir 800mg 5x/d. I would refer him to an ophthalmologist for full ophthalmological assessment.