Station - Instructions for candidate
You are an intern in the cardiology outpatient clinic of a Perth teaching hospital.
Ray Thompson, a 70-year-old retired fisherman, has atrial fibrillation that keeps coming back despite treatment. His cardiologist saw him last week and has recommended starting amiodarone; the letter and his baseline tests are printed on your sheet. He is in sinus rhythm today. The registrar has asked you to counsel him and start the medicine.
| Cardiologist's letter (extract) | Paroxysmal atrial fibrillation, weekly symptomatic episodes despite metoprolol 50 mg twice daily and digoxin 125 microgram daily; relapse after cardioversion eight months ago. Warfarin, target INR 2-3 (CHA2DS2-VA 3). Echocardiogram: ejection fraction 50 percent, left atrium mildly dilated. Recommend amiodarone for rhythm control; please counsel, check baseline tests and commence loading. Ablation to be discussed if amiodarone fails or is not tolerated. |
|---|---|
| Baseline tests this week | TSH 2.1 mIU/L, free T4 15 pmol/L; ALT 28 U/L, ALP 70 U/L; chest X-ray clear; spirometry and gas transfer normal; ECG sinus rhythm 72, QTc 430 ms; INR 2.6; digoxin level 0.9 nmol/L; potassium 4.2 mmol/L |
Your tasks are to:
- Take a focused history.
- Counsel Mr Thompson on amiodarone.
- Outline the plan and agree it with him.
- You do NOT need to examine the patient.
- You do NOT need to summarise your findings to the examiner.
This is a 10-minute station, with 2 minutes of reading time.