Blood pressure skill

  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in general practice, you have been asked to take a blood pressure off this gentleman

Patient: 65 year old presents to his general practitioner to get his blood pressure checked

– Ascertain this patients blood pressure
– After 6 minutes you will be asked a series of questions by the examiner

Note to actor:Try to restrain yourself from volunteering to 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.

65 year old who has come to the general practitioner in order to get your blood pressure checked. This is not a history station, although you will be required to confirm your demographic information.

Category Question
Consent Candidate appropriately introduced themselves with:
Full name
Medical school, year or grade
Clarifies who they are examining
Gains consent for examination

Examination introduction Examination introduction
Washes hands
Appropriately explains the procedure
Appropriately exposes patient

Position Patient position
Arm should be extended and horizontal (in line with the heart)

Palpation Palpation
Brachial artery

Cuff placement Cuff placement
2 inches above cubital fossa
Arrow pointing to brachial artery

Cuff inflation Cuff inflation
Cuff inflated until brachial artery is no longer palpable

Auscultation Auscultation 1
Place stethoscope over the brachial artery and deflate slowly

Auscultation Auscultation
Place stethoscope over the brachial artery and deflate slowly
1st sound = systolic blood pressure
Sound disappearing = diastolic blood pressure

Repeat Repeat
Candidate repeats the blood pressure

Closure Procedure closure
Thank patient
Washes hands

Question This patients blood pressure is 160/100, what would be your next step to eliminate if this is a falsely elevated blood pressure reading
Perform ambulatory blood pressure monitoring

Question What is the associated morbidity with hypertension?
Heart failure
Renal failure

Question What are the causes of secondary hypertension?
Renal disease (accept one of) = Commonly caused by diabetic nephropathy, chronic glomerulonephritis, adult polycystic kidneys
Endocrine disease (accept one of) = Conn’s syndrome, adrenal hyperplasia, phaeochromocytoma, cushing’s syndrome and acromegaly
Coarctation of the aorta

Question What is the conservative management of hypertension
Weight reduction
Reduce alcohol consumption
Increase exercise
Stop smoking

Question What would be the first line medical therapy for this patient?
Calcium channel blocker (allow an example e.g amlodipine)