EXAMPLE OF AN OSCE OSPE EXAMINATION BOOK.doc

8/19/2019 EXAMPLE OF AN OSCE OSPE EXAMINATION BOOK.doc

1/51

EXAMPLE OF AN OSCE/OSPE EXAMINATION BOOK

Faculty of Health Sciences

THE UNIVERSITY OF THE WITWATERSRAND

MB BCh III / GEMP I

Integrated Ba!" Med!"a# and H$%an S"!en"e A

&SCMD'()*

Block Examination TwoPape !

OSCE / OSPE

Time" # hous #$ minutes

Stat!+n a##+,an"e- . %!n$te

#% &u'ust #$$!


2/51

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3/51

INSTRUCTIONS

YOU HAVE FIVE MINUTES TO READ THESE INSTRUCTIONS

$ Thee ae twenty six stations0 of which fou ae 1EST Stations2$ 3pposite is a map of you stations0 take a moment to stu)y it2$ Ten maks ae assi'ne) to each acti4e station2$ Two shot 5ell in's si'nal the stat of the 3SCE/3SPE0 63 73T M38E0 ea)

these instuctions2$ Two shot 5ell in's afte fi4e minutes si'nal the stat of the examination2

1EM&I7 &T THE S&ME ST&TI37 an) stat acco)in' to the instuctions 5othat the station an) in this 5ook2

$ & lon'e 5ell in' in)icates the en) of each fi4e9minute inte4al when you mustmo4e to the next station2

$ Mo4e in a clockwise )iection2$ &ny can)i)ate o5stuctin' anothe may lose his o he maks fo the next

station2$ Thee ae fou stations with o5se4es :examines; an) Simulate) Patients

:SP;0 please 'eet them an) into)uce youself to 5oth the examine an) theSP2 Hand a #a3e# t+ t4e e5a%!ner6

$ If the examine nee)s to pompt you half a mak may 5e )e)ucte)2$ Make sue that you ha4e attempte) all the


4/51

STATION )

At t4! tat!+n t4ere ! a S!%$#ated Pat!ent 0r+% ,4+% 8+$ 4+$#dta9e a 4!t+r8 ,!t4 t4e "+%+nent #!ted 3e#+,6

Y+$ %a8 %a9e n+te +n t4! age and $e t4e% t+ an,er t4e:$et!+nna!re at t4e ne5t tat!+n6

)6 Per+na# Deta!#

;6 Preent!ng C+%#a!nt

'6 2enera# Hea#t4 Stat$


5/51

STATION ; >)( %ar9?

@$et!+n )

a* > %ar9?

3* > %ar9?

"* >) %ar9?

@$et!+n ; >; %ar9?

@$et!+n 'a* > %ar9?

3* > %ar9?

@$et!+n <Ca$e )

a* > %ar9?

3* > %ar9?

Ca$e ;a* > %ar9?

3* > %ar9?

@$et!+n .>) %ar9?

@$et!+n >; %ar9?

Mar9


6/51

STATION ' >)( %ar9?

HAND A STICKER TO THE EXAMINER

At t4! tat!+n t4ere ! a S!%$#ated Pat!ent and anE5a%!ner ,4+ ,!## %ar9 8+$r de%+ntrat!+n a9 8+$:$et!+n and %ar9 t4e an,er6

Re%e%3er- e5#a!n 3r!e0#8 e=er8t4!ng 8+$ d+ ,!t4 a "+%%entar86

)6 De%+ntrate 38 a3d+%!na# a#at!+n 4+, t+ "+n0!r% t4ereen"e +0 an en#arged #!=er

>< %ar9?

;6 De%+ntrate 4+, t+ deter%!ne t4e #!=er an>' %ar9?

'6 De%+ntrate t4e anter!+r #e=e# ,4!"4 t4e t+ +0 t4e d!a4rag%rea"4e !n n+r%a# :$!et re!rat!+n

>) %ar9?

) %ar9?

.6 2!=e t,+ "a$e +0 an en#arged and a#a3#e #!=er >) %ar9?


7/51

STATION < >)( %ar9?


At t4! tat!+n t4ere ! a S!%$#ated Pat!ent and an E5a%!ner ,4+,!## %ar9 8+$r de%+ntrat!+n a9 8+$ :$et!+n and %ar9 t4ean,er6 E5#a!n 3r!e0#8 e=er8t4!ng 8+$ d+6

F!rt read t4e "#!n!"a# "enar!+

Y+$ are !n "a$a#t8 ,4en a 4!a"9 =!"t!% ! 3r+$g4t !n 38a%3$#an"e 0+##+,!ng a ta33!ng t+ t4e anter!+r r!g4t "4et6 T4eat!ent ! 3e"+%!ng !n"rea!ng#8 3reat4#e and 8+$ n+te are!rat+r8 rate +0 '. 3%6 T4e tra"4ea ! "#ear#8 de=!ated t+ t4eat!ent #e0t6

)6 W4at %!g4t 3e rea+na3#8 "+n!dered t4e "a$e +0 t4eat!ent 3reat4#ene&T4e e5a%!ner ,!## te## 8+$ !0 8+$ d+nt 9n+, t4e an,er6*

>) %ar9?

;6 De%+ntrate 4+, 8+$ %!g4t "+n0!r% t4e d!agn+! ,4en

tand!ng 3e4!nd t4e at!ent +n#86 C#ear#8 tate ,4at 8+$ ,+$#de5e"t t+ 0!nd !n t4! "ae a 8+$ de%+ntrate 8+$r e5a%!nat!+n6

>G %ar9?

'6 W4!"4 !de +0 t4e "4et 4+, t4e a%e at4+#+g8 +n t4erad!+gra4 and ,48 2!=e t,+ rea+n6

>; %ar9?


8/51

STATION .

REST STATION


9/51

STATION >)( %ar9?

AT THIS STATION THERE IS A POWERPOINT LOOP.

THERE ARE FOUR SLIDES IN THE LOOP.

USE THE SLIDES TO ANSWER THE QUESTIONS ON THE

FOLLOWING PAGE.

F. INITIALISES THE LOOP

PA2E UP MOVES BACK

PA2E DOWN MOVES FORWARDS

ESC and t4en F. STOPS AND THEN RESTARTS THE LOOP ATTHE FIRST SLIDE


10/51

STATION >)( %ar9?

QUESTIONNAIRE

S#!de ;

)6 W4at ! t4e at4+#+g!"a# ter% g!=en t+ t4e %a"r+"+!"aearan"e 4+,n !n 3+t4 F!g ) and ; >; %ar9?

S#!de '

;6 W4at ! t4e at4+#+g!"a# na%e 0+r t4e d!eae r+"eeen !n 3+t4 F!g ' and ; %ar9?

'6 W4at are t4e %a!n t8e +0 "e## !n t4e "enter +0 t4e$#%+nar8 tr$"t$re 4+,n !n F!g ; %ar9?

; %ar9?


11/51

Mar9


12/51

STATION G



)6 Per+na# Deta!#




13/51

STATION >)( %ar9?

@UESTIONNAIRE

@$et!+n )

a* > %ar9?

3* > %ar9?

@$et!+n ;a* &!* > %ar9?

&!!* > %ar9?

3* > %ar9?

@$et!+n 'a* >) %ar9?

3* Ye N+ > %ar9?

"* > %ar9?

@$et!+n <>) %ar9?

@$et!+n .

)6 > %ar9?

;6 > %ar9?

C+nt!n$ed +n ne5t age6 P#eae t$rn +=er6


14/51

STATION "+nt!n$ed

@$et!+n a* > %ar9?

3* > %ar9?

"* > %ar9?

@$et!+n G >) %ar9?

@$et!+n >) %ar9?

Mar9


15/51

STATION


THERE ARE FIVE SLIDES IN THE LOOP.


FOLLOWING PAGE.


PA2E UP MOVES BACK




16/51

STATION >)( %ar9?

@UESTIONNAIRE

S#!de ;

)6W4!"4 #8%4 tat!+n ! )

> %ar9?

;6 W4!"4 #8%4 tat!+n ! ; > %ar9?

'6 W4!"4 #8%4 tat!+n > %ar9?

)6( %ar9?



17/51

STATION &"+nt!n$ed*

S#!de <

6 Na%e t4e t4ree %!dd#e reg!+n- ; . and

;

>' %ar9?

.

S#!de .

6 Ident!08 t4e art +0 t4e #arge 3+,e# !nd!"ated 38t4e arr+,

> %ar9?

)(6 Ident!08 t4e art +0 t4e #arge 3+,e# !nd!"ated 38t4e arr+,

> %ar9?

))6 Ident!08 t4e art +0 t4e #arge 3+,e# !nd!"ated 38t4e arr+,

> %ar9?

);6 Ident!08 t4e art +0 t4e #arge 3+,e# !nd!"ated 38t4e arr+,

> %ar9?

Mar9


18/51

STATION )(

REST STATION


19/51

STATION )) >)( %ar9?


At t4! tat!+n t4ere ! a S!%$#ated Pat!ent and an E5a%!ner ,4+,!## %ar9 8+$r de%+ntrat!+n a9 8+$ :$et!+n and %ar9 t4ean,er6 E5#a!n 3r!e0#8 e=er8t4!ng 8+$ d+ and en$re t4at 8+$g!=e t4e "+rre"t !ntr$"t!+n t+ t4e S!%$#ated Pat!ent6

F!rt read t4e "#!n!"a# "enar!+-

T4e at!ent 4a "+%e t+ 8+$ ,!t4 a re!rat+r8 r+3#e% 8+$ de"!de!t ,+$#d 3e $e0$# t+ "arr8 +$t a 0#+, =+#$%e #++ +n t4e at!ent6

)6 2enerate a 0#+,1=+#$%e #++ 0+r t4e S!%$#ated Pat!ent6>. %ar9?

;6 U!ng t4e 0#+,1=+#$%e #++ generated +n "reen 0+r t4eS!%$#ated Pat!ent !dent!08 4+, 8+$ ,+$#d read +00 t4e0+##+,!ng =ar!a3#e 0r+% t4e #++-

a6 FVC36 FEV)"6 PEFRd6 Pred!"ted =a#$e

>< %ar9?

'6 Na%e a re!rat+r8 d!+rder t4at re$#t !n an FEV)- FVC rat!++0 #e t4an (6

>) %ar9?


20/51

STATION );


THERE ARE SIX SLIDES IN THE LOOP.


FOLLOWING PAGE.


PA2E UP MOVES BACK




21/51

STATION ); >)( %ar9?

S#!de ;

)6 Na%e t,+ a""e+r8 %$"#e +0 re!rat!+n ,4!"4%a8 3e 3r+$g4t !nt+ a"t!+n !n t4! at!ent6 >; %ar9?

S#!de '

;6a* H+, ! t4e aten"8 +0 t4e tr$"t$re !n A

%a!nta!ned >) %ar9?

3* H+, ! t4e aten"8 +0 t4e tr$"t$re !n B%a!nta!ned >) %ar9?

S#!de <

'6a* Na%e +ne 0eat$re t4at 8+$ ,+$#d #++9 0+r !n +rder

t+ "+n0!r% ne$%+t4+ra56 >) %ar9?

3* I t4e d!agn+! +0 ne$%+t4+ra5 #!9e#8 2!=e area+n 0+r 8+$r an,er6 >) %ar9?



22/51

STATION ); &"+nt!n$ed*

S#!de .

%ar9?

3* Ident!08 > %ar9?

"* Na%e t4e =ee# t4at "arr8 +58genated 3#++d0r+% t4e #$ng t+ t4e #e0t !de +0 t4e 4eart6 >) %ar9?

S#!de

.6a* At ,4at =erte3ra# #e=e# d+e t4e tra"4ea d!=!de >) %ar9?

3* I0 a 0+re!gn 3+d8 ! !n4a#ed !t ! %+re #!9e#8 t+ entert4e r!g4t %a!n 3r+n"4$ t4an t4e #e0t6 W4at ! t4eanat+%!"a# rea+n 0+r t4! >) %ar9?

Mar9


23/51

STATION )'


THERE ARE THREE SLIDES IN THE LOOP.


FOLLOWING PAGE.


PA2E UP MOVES BACK


ESC and t4en F. STOPS AND THEN RESTARTS THE LOOP AT

THE FIRST SLIDE


24/51

STATION )' >)( %ar9?

S#!de ;

)6 W4at ! t4! %et4+d +0 :$ant!08!ng t4e d!eae"a##ed >) %ar9?

;6 W4at at4+#+g!"a# "4ange ! 3e!ng et!%ated >) %ar9?

'6 At ,4at #e=e# d+e t4! %ea$re%ent 3e"+%eat4+#+g!"a##8 !gn!0!"antT!"9 "+rre"t an,er6 >) %ar9?

a* ;(

3* ) %ar9?

S#!de '

.6 W4at ! t4e na%e g!=en t+ t4! rearat!+n and,4at +rgan ! rereented >) %ar9?

6 W4at at4+#+g!"a# r+"e ! reent !n t4e area3et,een t4e arr+, at A >) %ar9?



25/51

STATION )' &"+nt!n$ed*

G6 W4at eg%ent +0 t4e a!r,a8 "+nd$"t!+n 8te%! a00e"ted !n t4! d!eae >) %ar9?

6

a* W4at at4+#+g!"a# #e!+n ! !nd!"ated 38 t4earr+, at B

>) %ar9?

3* W4at "+%#!"at!+n "an t4e #e!+n at B $nderg+and ,4at ! t4e "#!n!"a# "+ne:$en"e

>; %ar9?

Mar9


26/51

STATION )<


THERE ARE FIVE SLIDES IN THE LOOP.


FOLLOWING PAGE.


PA2E UP MOVES BACK




27/51

STATION )< >)( %ar9?

S#!de ;

)6a* W4at t,+ 0eat$re d+ 8+$ ,!4 t+ "+%%ent +n ,4en

#!ten!ng t+ 3reat4 +$nd d$r!ng a$"$#tat!+n >; %ar9?

3* Are 8+$ #!ten!ng t+ n+r%a# 3reat4!ng +r 3r+n"4!a#

3reat4!ng > %ar9?

S#!de '

;6a*

W4at a3n+r%a#!t8 "an 8+$ !dent!08 +n t4e "4etrad!+gra4 > %ar9?

3*W4at t8e +0 3reat4!ng "an 8+$ 4ear +=er t4e a3n+r%a#area

>) %ar9?

"* Na%e +ne "+nd!t!+n !n ,4!"4 8+$ %a8 4ear t4! t8e +0 3reat4!ng6 > %ar9?



28/51

STATION )< "+nt!n$ed


29/51

S#!de <'6

a* W4at added sound "an 8+$ 4ear >) %ar9?

3* H+, ! t4! +$nd generated > %ar9?

"* Na%e +ne "+nd!t!+n !n ,4!"4 8+$ %a8 4ear t4! +$nd > %ar9?

d* W4at ! t4e d!00eren"e 3et,een tr!d+r and a

,4eeJe

>) %ar9?

S#!de .

%ar9?

!!* > %ar9?

Mar9

STATION ).


30/51

AT THIS STATION THERE IS A RADIO2RAPH VIEWIN2 BOX6ANSWER THE @UESTIONS RELATIN2 TO THE CHESTRADIO2RAPHS6

EXAMPLE OF A BASIC DIA2RAM TYPE TO BE USED IN @) d*6


31/51

STATION ). >)( %ar9?

CHEST RADIO2RAPH N+6 ))6

a* W4at ! t4e %+t !%+rtant t4!ng t+ "4e"9 ,4en=!e,!ng a "4et rad!+gra4

> %ar9?

3* !* I t4! at!ent %a#e +r 0e%a#e> %ar9?

!!* 2!=e a rea+n 0+r 8+$r an,er > %ar9?

"* Ident!08 t4e tr$"t$re a"e +r 4ad+, #a3e##ed) <

>; %ar9?

)6

;6

'6


32/51

STATION ). &"+nt!n$ed*

CHEST RADIO2RAPH N+6 ;;6

a* W4at =!e, ! t4! > %ar9?

3* Ident!08 t4e tr$"t$re #a3e##ed ) and ;

)6

>; %ar9?

;6

CHEST RADIO2RAPH N+6 '

'6 C+%are rad!+gra4 ) ,!t4 rad!+gra4 '6

2!=e t,+ rea+n ,48 t4! AP "4et rad!+gra4 !d!00erent 0r+% "4et rad!+gra4 )6

>; %ar9?

!*

!!*

Mar9


33/51

STATION )


THERE ARE SIX SLIDES IN THE LOOP.


FOLLOWING PAGE.


PA2E UP MOVES BACK




34/51

STATION ) >)( %ar9?

@UESTIONNAIRE

S#!de ;

)6 W4!"4 reg!+n&* +0 t4e 4ar8n5 4a=e 3e"+%e,+##en and red

>) %ar9?

S#!de '

;6 W4at tr$"t$re d+e t4e !n0e"t!+n tra=e# t4r+$g4 t+rea"4 t4e tr$"t$re !n F!g )

>) %ar9?

S#!de <

'6

a* W4at 3+ne are re+n!3#e 0+r ena3#!ng t4etr$"t$re !n F!g ) t+ 0$n"t!+n n+r%a##86

>) %ar9?

3* W4at ! t4e !nner=at!+n +0 t4e %e%3rane +=er t4etr$"t$re !n F!g )

>) %ar9?



35/51

STATION ) &"+nt!n$ed*

S#!de .

) %ar9?

3* De"r!3e t4e at4+#+g!"a# "4ange !n t4e tr$"t$re

!n F!g ;6

>; %ar9?

S#!de

.6

a* W4at ! t4e !nner=at!+n +0 t4e tr$"t$re !n F!g ; >) %ar9?

3* What is the arterial blood supply to the structure in Fig2?

>) %ar9?

"* W4at ! t4e 0$n"t!+n +0 t4! tr$"t$re >) %ar9?


36/51

Mar9


37/51

STATION )G

REST STATION


38/51

STATION )



)6 Per+na# Deta!#



THE PATIENT IS COMIN2 BACK TO HER DOCTORAT THE BANK6 SHE IS NERVOUS


39/51

STATION ) >)( %ar9?

@UESTIONNAIRE

@$et!+n )

a* > %ar9?

b)> %ar9?

@$et!+n ;

YES NO N > %ar9?

Question 3

a* > %ar9?

3* > %ar9?

"* > %ar9?

Question 4

!* >) %ar9?

!!*>) %ar9?

!!!* >) %ar9?

C+nt!n$ed +n t4e ne5t age6 P#eae t$rn +=er6


40/51

STATION ) &"+nt!n$ed*

Question 5 >; %ar9?

@$et!+n

a* > %ar9?

3* > %ar9?

@$et!+n G

!* > %ar9?

!!* > %ar9?

Mar9


41/51

STATION ;( >)( %ar9?



)6a* H+, %an8 ne$r+ne %a9e $ a re0#e5 ar" > %ar9?

3* H+, %an8 8nae are t4ere !n a re0#e5 ar" > %ar9?

;6 C+%#ete t4e 0+##+,!ng ta3#e-

REFLEX NERVEROOTS

NERVE

C, :C%; Musculo9Cutaneous > %ar9?

Ticeps =ek 1a)ial > %ar9?

'6 De%+ntrate t4e KNEE ERK REFLEX ,!t4 t4e at!ent !nt4e SUPINE +!t!+n6 E5#a!n 3r!e0#8 e=er8t4!ng 8+$ d+6

> %ar9?

) %ar9?


42/51

STATION ;) >)( %ar9?



FIRST READ THE CLINICAL SCENARIO-

T4e at!ent reent ,!t4 a 0+$r da8 4!t+r8 +0 0e=er r+d$"t!=e"+$g4 &8e##+, $t$%* and r!g4t !ded "4et a!n +n !n!rat!+n6

)6 W4at ! t4e %+t #!9e#8 "a$e +0 t4e r!g4t1!ded "4et a!n>) %ar9?

THE EXAMINER WILL SHOW YOU A CHEST RADIO2RAPH

;6 W4at at4+#+g!"a# "+nd!t!+n %!g4t t4! at!ent 4a=e>) %ar9?

'6 W4at ! t4e %+t #!9e#8 "a$at!=e +rgan!%

> %ar9?

De%+ntrate $!ng t4e FRONT +0 t4e S!%$#ated Pat!ent +n#8 t4ee5a%!nat!+n te"4n!:$e t+ "+n0!r%-

a* red$"ed aerat!+n +n t4e r!g4t >) %ar9?

3* !n"reaed =+"a# 0re%!t$ +n t4e r!g4t >; %ar9?

.6 W4at t8e +0 3reat4!ng ,+$#d 8+$ e5e"t t+ 4ear +na$"$#tat!+n +=er t4e a00e"ted area

>) %ar9?

6 W4at "+nd!t!+n re$#t !n Qt+n8 d$##ne and2!=e t,+ at4+#+g!e t4at %a8 re$#t !n !t6

>' %ar9?


43/51

STATION ;;

T4ere ! a data 4eet and t4ree 0!g$re 0r+% a at!ent ,4+ reent,!t4 t4e r+3#e% de"r!3ed 3e#+,6

On t4e :$et!+nna!re ++!te are a er!e +0 :$et!+n 3aed +nt4! at!ent r+3#e%6

A 58-year-old woman presents to er !amily do"tor wit tirednessand eada"es !or te last tree monts# Se as also noti"ed a"an$e in er %owel a%its !rom on"e daily and !ormed to two - tree times daily and semi-!ormed#

F!g ) and ; are t,+ +3=!+$ "#!n!"a# 0!nd!ng 0+$nd 38 t4e d+"t+r +n genera# !ne"t!+n and Ta3#e ) g!=e t4e 4ae%at+#+g!"a# !nd!"e0r+% a r+$t!ne 3#++d tet and F!g ' ! t4e 3#++d %ear 0r+% t4ea%e at!ent6


44/51

STATION ;; >)( %ar9?

)6 De"r!3e t4e 0!nd!ng !n F!g ) and ; >; %ar9?

F!g )6

F!g ;6

;6 W4at are t4e FBC !nd!"e !nd!"at!=e +0 !n "+n$n"t!+n,!t4 t4e "#!n!"a# 0!nd!ng

>) %ar9?

'6 De"r!3e t4e aearan"e +0 t4e red "e## !n t4eat!ent %ear 4+,n !n F!g ' and !dent!08 t4e "e## 3and "

a* >; %ar9?

3* Ce## B >) %ar9?

"* Ce## C >) %ar9?


45/51

STATION ;'



)6 Per+na# Deta!#




46/51

STATION ;< >)( %ar9?

@UESTIONNAIRE

@$et!+n )

!6 >) %ar9?

!!6 >) %ar9?

@$et!+n ;

a* > %ar9?

3* > %ar9?

"* >) %ar9?

@$et!+n '

> %ar9?

@$et!+n <

a* !* > %ar9?

!!*> %ar9?

&ontinued on ne't pa$e# (lease turn o)er#


47/51

STATION ;< "+nt!n$ed

Question 4 *"ontinued+

3*!*

> %ar9?

!!*> %ar9?

@$et!+n .

a* >) %ar9?

3* >) %ar9?

@$et!+n

a* > %ar9?

3*

,ould you ear tese sounds %ilaterally orunilaterally Ti". te "orre"t %o'#

3!#atera##8 $n!#atera##8

> %ar9?

@$et!+n G

> %ar9?

Mar9


48/51

STATION ;.

Y+$ are r+=!ded ,!t4-

E54!3!t A- 2ra%1ta!n +0 t4e at!ent $t$%

E54!3!t B- T4e at!ent "4et rad!+gra4

On t4e :$et!+nna!re ++!te are a er!e +0 :$et!+n 3aed+n t4! at!ent r+3#e%6

A . 8ear +#d %an ,!t4 0e=er and a r+d$"t!=e "+$g4 ,aad%!tted t+ 4+!ta# a0ter 4e 3e"a%e !n"rea!ng#8 4+rt +0

3reat46 He 4ad a te%erat$re +0 '6.+C a $#e rate +0 );(3eat / %!n$te and a re!rat+r8 rate +0 ;; 3reat4 / %!n$te6C4et e5a%!nat!+n re=ea#ed red$"ed e5an!+n +n t4e r!g4tand d$##ne t+ er"$!+n and a3ent 3reat4 +$nd !n t4er!g4t %!dJ+ne6 T4e at!ent "+$g4 ,a r+d$"t!=e +0 $r$#ent green "+#+$red $t$%6

B#++d gae +n arter!a# 3#++d "+##e"ted ,4!#e t4e at!ent ,a3reat4!ng r++% a!r "+n0!r%ed a 48+5!a and re!rat+r8

a"!d+!6


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STATION ;. >)( %ar9?

)6a* W4at ! 8+$r "#!n!"a# d!agn+! >) %ar9?

3* W4at ! t4e %+t #!9e#8 "a$at!=e agent >) %ar9?

;6 L!t ' +t4er 3a"ter!a t4at are a+"!ated ,!t4 t4!d!eae !n t4e "+%%$n!t8 ett!ng >' %ar9?

!*

!!*

!!!*

'6 W4at +t4er %!"r+3!+#+g!"a# !n=et!gat!+n %a8 4a=e3een 4e#0$# !n t4e d!agn+! +0 t4! at!ent

"+nd!t!+n >; %ar9?



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STATION ;. :continue);

; %ar9?

.6 H+, "an t4! d!eae 3e re=ented >) %ar9?

Mar9


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STATION ;

REST STATION

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