Simulated Patient Instructions



Patient InstructionsName of Patient:Mary BerryDescription of the patient & instructions to simulator:A 65 yr old lady with a 10 day history of headache. Recently (1 month ago) had Amlodipine dose increased. Wonders if it is the tablet and whether she needs to switch treatment. Has read the Patient Information Leaflet and headache is one of the side effects.Also feeling a bit achy and has read the PILeaflet which says statins cause muscle painStarts the consultation 'I wonder if I need to change my tablets doctor, as they are upsetting me' Nature of headacheParticularly bad over right temple. Jaw aches with eating (only if asked)Feels generally unwell with it; tired, a little sickly and off food.No visual symptoms (only if asked)No vomiting. No positional symptoms. No neuro symptoms. (only if asked)Paracetamol has not really helped. Not tried much else. Idea: It's the tablets Concern: Worried it's the tables and her symptoms are have started to affect her baking performance - Womens Institute annual baking competition is on the horizon.Expectation: Wants to get better with a switch in tablets. Would also like something to help with pain, regards the upcoming WI baking competition.PMH/DH: HT Hypertension - Takes Amlodipine 10mg a dayOn Atorvastatin 20mg for primary prevention. Doctor’s (GP ST) InstructionsName & age of patient Mary Berry age 65Summary CardPMH: HTDH: Atorvastain 20mg, Amlodipine 10mgAllergies: None Case Notes - Last few entries in records:From 1 month agoBP not at QOF target - increase Amlodipine to 10mgCSA EXAMINATION CARDPatient Name: Mary BerryExamination findings:Tender over temples/ temporal artery BP 150/80Fundoscopy normal.Visual fields normal.CSA Case Marking SheetCase Name: TACase Title:Context of case New onset temporal arteritisAssessment Domain:1.Data-gathering, technical and assessment skillsPositive descriptors: Asks about jaw claudication and scalp tendernessAsks about visual loss/symptomsAsks about PMR symptomsRule out other headache red flagsAppropriate exam-Including BP, fundi, CNS and Temporal artery tenderness. Elicits ICE and psychosocial impact Negative descriptors:Does not check for visual loss/problems. Does not rule out headache red flags Fails to examine or examination incompleteFails to elicit SPICE. Assessment Domain:2.Clinical Management SkillsPositive descriptors: Explains likely diagnosis in simple way.Explains risk of not treating (esp. re vision) Explains initial treatment and investigations(steroids and ESR/ CRP)Explains need for referral for urgent biopsy for definitive diagnosis and then referral on to Rheumatology Explains need for aspirin and possible bone protection as wellOffers simple analgesia to help in her baking preparationSafety nets re. visionMakes a sensible plan for tests, referral and follow-upNegative descriptors:Does not make a diagnosis of TAExplanation unclear.Fails to order investigations to confirm suspicion. Fails to start appropriate treatment. Safety netting not done, not appropriate or not explained. Assessment Domain:3. Interpersonal skillsGood rapportElicits and uses SPICE Explains diagnosis, management and reason for safety netting in appropriate language.Shared decision making Checks for understanding of complex tablet plan.Doesn’t use SPICEFails to explain things clearly to patient. Offers options inappropriately or without heavy spinning.No shared decision making ................
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