Station - Instructions for candidate
You are a final-year medical student on placement in a general practice in Kelmscott. Your supervising GP has asked you to see this patient and his daughter first, in a long appointment.
Trevor Dawson, 76, has been brought in by his daughter Karen, who booked the appointment because she is worried about his memory. Both are in the room.
| Practice record | Hypertension. Urinary urgency. Insomnia. Ex-smoker. Medicines: perindopril 5 mg daily, atorvastatin 20 mg at night, amitriptyline 25 mg at night, oxybutynin 5 mg twice daily. No allergies. Last seen 4 months ago for a repeat prescription. |
|---|---|
| Observations (practice nurse) | HR 72 /min regular, BP 146/84 mmHg sitting, 138/80 mmHg standing, T 36.6 degrees C, SpO2 97% on room air, weight 74 kg (77 kg one year ago) |
Your tasks are to:
- Take a focused history of the memory concern from Mr Dawson and, with his permission, from his daughter, including a brief cognitive screen. The examiner will provide the screening scores.
- Screen the domains of a geriatric assessment: function, falls, mood, continence, nutrition, medicines, hearing, driving, safety and supports.
- Request the investigations you would arrange. The examiner will provide results where appropriate.
- State your most likely diagnosis and the differential diagnoses to the examiner.
- Outline your initial management plan to the examiner and explain the next steps to Mr Dawson and his daughter.
- You do NOT need to perform a physical or neurological examination.
- You do NOT need to summarise your findings to the examiner.
- A GPCOG and an MMSE form are on the table; you may administer either and the examiner will give the score.
This is a 15-minute station, with 2 minutes of reading time.