Station - Instructions for candidate
You are a junior doctor working in a general practice in Perth.
Carmela Caruso, a 56-year-old primary school teacher, had a raised blood pressure reading at a routine check a month ago. She has since had a second clinic reading, a week of home monitoring with a validated cuff, bloods and an ECG, all printed below. She has come back to discuss the results. The practice nurse has measured her blood pressure again today.
| Blood pressure today (practice nurse, seated, average of two) | 156/94 mmHg; HR 74 /min; weight 78 kg, height 164 cm, BMI 29 kg/m2, waist 94 cm |
|---|
Results provided:
Blood pressure record, bloods and ECG
| Item | Value | Reference range |
|---|---|---|
| Clinic blood pressure, visit 1 (4 weeks ago) | 158/96 mmHg | <140/90 mmHg |
| Clinic blood pressure, visit 2 (2 weeks ago) | 156/94 mmHg | <140/90 mmHg |
| Home blood pressure, 7-day average (28 readings, validated upper-arm cuff) | 152/94 mmHg | <135/85 mmHg |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Creatinine | 70 umol/L | 45-90 umol/L |
| eGFR | 88 mL/min/1.73m2 | >60 mL/min/1.73m2 |
| Urine albumin-creatinine ratio | 1.2 mg/mmol | <3.5 mg/mmol |
| Fasting glucose | 5.4 mmol/L | 3.5-5.4 mmol/L |
| Total cholesterol | 6.1 mmol/L | <5.5 mmol/L |
| LDL cholesterol | 3.9 mmol/L | <2.0 mmol/L |
| HDL cholesterol | 1.4 mmol/L | >1.0 mmol/L |
| Triglycerides | 1.6 mmol/L | <2.0 mmol/L |
| ECG | Sinus rhythm 74 /min; normal axis; no left ventricular hypertrophy; normal | Normal |
Non-smoker. No diabetes. Australian CVD risk calculator: approximately 7% risk of a cardiovascular event over 5 years (intermediate risk).
Your tasks are to:
- Take a focused history relevant to these results and to starting treatment.
- Explain the results and what they mean to Mrs Caruso in plain language.
- Counsel her on starting an ACE inhibitor (perindopril), including how to take it, side effects, when to withhold it, the monitoring required, and the lifestyle changes that will help.
- You do NOT need to examine the patient.
- You do NOT need to summarise your findings to the examiner.
- You do not need to write a prescription in this station, but state the drug, dose and frequency.
This is a 10-minute station, with 2 minutes of reading time.