Reset 10 mins Pause Candidate instructionsActor instructionsMark sheet Score Location: Foundation doctor, general practice Patient: Luke Richardson, 60 years old, has been having problems with leg pain Task: – Take a focused history from the patient – After 6 minutes you will be asked a series of questions by the examiner. – Answer any questions that the patient may have Note to actor:Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required. You are a 60 year old called Luke Richardson, who has come to see the GP because you have been getting some pains in your legs, more specifically your calves. You first started to notice this about 6 months ago, you thought this would go away by by its self but it has been getting worse. You are now only able to walk about 40m before the pain comes on. Over the past couple of weeks you have been getting the pain at night but have noticed that hanging your legs over the side of the bed has been making the pain better. The pain is much worse when exercising and seems to go away after a few minutes at rest. PMH – high blood pressure, angina, mini stroke, high cholesterol, type 2 diabetes DH – Amlodipine, Ramipril, Aspirin, Simvastatin, GTN spray, Metformin, Gliclazide. No known drug allergies FH – Dad died of a stroke, mother of a heart attack SH – 30 cigarettes per day, drink 5 pints of beer per day, live with your partner, ex-taxi driver If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection. Category Question Done Excellent Introduction Candidate appropriately introduced themselves with: Full name Role Clarifies who they are talking to Asks patient for preferred name HPC History of presenting complaint Site Onset Character Radiation Pain on exertion Exercise distance Additional history Pain better with rest Pain at night No ulcers No skin changes PMH Past medical history High blood pressure, angina, mini stroke, high cholesterol, type 2 diabetes DH Drug history Amlodipine, Ramipril, Aspirin, Simvastatin, GTN spray, Metformin, Gliclazide. No known drug allergies SH Social History Alcohol Smoking Job Living situation FH Family history Family history appropriately asked about ICEF ICEF Explores ideas, concerns, expectations, feelings Question Given your history, what are your differentials? Peripheral vascular disease / intermittent claudication Deep vein thrombosis Osteoarthritis Spinal claudication Musculoskeletal injury Question Given the history, what bedside investigations would you do in this patient? Ankle-brachial pressure index Blood pressure Question What is the conservative management of this patient? Stop smoking BP control Weight loss Exercise Submit your answers to get your score.