Case 4: 77yr old woman admitted via GP with fluctuating consciousness.
|
|||
|
|
|
|
Observations & Interpretations
Mammograms: Background of low density breasts. There is a large mass in the inner quadrant of the left breast. This causes some tethering and speculation, and contains some suspicious micro-calcifications. There are also some benign calcifications in the right breast.CT Head: On the plain CTH there is moderate ventriculomegaly, and the suggestion of sulcal effacement in the vertex. On post-contrast sequences there is leptomeningeal enhancement, best seen in the vertex. No focal intracranial mass lesions.
Principal Diagnosis
Breast cancer with leptomeningeal spread.Differential Diagnosis
Meningitis as another cause of leptomeningeal enhancement.Management
Oncological review| Marking Scheme | ||
|---|---|---|
| 3 | Nothing | Nothing Written |
| 4 | Fail | Significant Observations Missed. No Mention of Correct Diagnosis |
| 5 | Borderline | Some Observations Missed. Only 1 of the main diagnoses suggested |
| 6 | Pass | Most observations made. The main diagnoses are made (at least in differential) |
| 7 | Good Pass | Observations made. Principal Diagnoses are all correct, and there is good reasoning. |
| 8 | Perfect Answer | Clear, Concise & Confident. Good Reasoning, and no unrealistic differentials |
You should mark yourself realistically. Some cases will be hard, and just making the relevant observations and sensible observations will give you a pass. Some cases will seem easy, and it is these cases you need to be scoring 7 or 8. In the exam if you write something very incorrect, or if you put down too many obscure differentials, then half marks can be deducted from your score. Make sure you include relevant negatives. If you think there is only 1 differential then be confident, and don't put down unlikely diagnoses. Make sure your handwriting is clear, and use bullet-points to make it more readable. Timing is crucial, and don't spend too long on a single case. As you will note from the mark scheme, if you put nothing down you get a 3. So simply writing a single observation gives you a point
.