Some Drills On Station 5 (Part 2)

Stem: Look at this patient and proceed.




Suggested presentation:

I would be very much interested in knowing his blood pressure and I would complete my examination by examining the visual field and dipstick his urine for glycosuria.
(Examiner: "His blood pressure is 110/80mmHg and there is no visual field abnormalities")

This patient has acromegaly as suggested by his coarse facies and spade-like fingers. There are prominent supraorbital ridges and the nose and mouth are both relatively big with evidence of overbiting of the lower jaw. On inspection of his oral cavity, there is macroglossia with interdental separation. Tinel's sign is negative. There is no axillary skin tags and excessive sweating. Coupled with a normal blood pressure and normal visual field, I think the disease activity is currently quiscent.

NB: As demonstrated in this case, candidates should not be taken aback by information offered by the examiners midway during your presentation. Instead, you should be keen to expect responses from examiners since that information is important in formulating the complete diagnosis.