Station - Instructions for candidate
You are a medical student on placement in a general practice in Albany.
Joan Harper, a 74-year-old retired schoolteacher, was found to have an irregular pulse at a routine check two weeks ago. Her ECG, echocardiogram and bloods are summarised on your sheet. The GP has decided to start apixaban and has asked you to see her, explain why, and counsel her on the medicine.
| Results summary | ECG: atrial fibrillation, ventricular rate 88. Echocardiogram: mildly dilated left atrium, normal valves, ejection fraction 60 percent. Bloods: Hb 128, platelets 230, creatinine 80 (eGFR 65), ALT 24, HbA1c 6.9 percent, TSH 2.0. Weight 68 kg. Past history: hypertension, type 2 diabetes. Current medicines: perindopril 4 mg, metformin 1 g twice daily, atorvastatin 20 mg. |
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| Practice nurse observations today | Pulse 88 irregularly irregular, BP 138/82 mmHg, SpO2 97% on room air, temperature 36.5 C |
Your tasks are to:
- Take a focused history.
- Counsel Mrs Harper on apixaban.
- Outline the plan and agree it with her.
- 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.