Intermittent Claudication


  • Candidate Instructions
  • Actor Instructions
  • Mark 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



Score