Station - Instructions for candidate
You are an intern in the heart failure clinic of a Perth teaching hospital.
Peter Kowalski, a 61-year-old bus driver, is attending two weeks after his first admission with heart failure. He knows he has a 'weak heart' after his heart attack. The discharge summary extract is printed on your sheet. The clinic nurse has recorded his observations and weight. The registrar has asked you to see him, explain his condition and go through his new medicines.
| Discharge summary (extract) | Admitted with decompensated heart failure three weeks after an anterior myocardial infarction treated with a drug-eluting stent. Echocardiogram: ejection fraction 30 percent, anterior and apical akinesis. Discharged on perindopril 2.5 mg daily, bisoprolol 1.25 mg daily, spironolactone 25 mg daily, dapagliflozin 10 mg daily, furosemide 40 mg each morning, aspirin 100 mg, atorvastatin 80 mg. Discharge bloods: K 4.6, creatinine 92, eGFR 78. Plan: up-titrate in clinic; cardiac rehabilitation referral sent. |
|---|---|
| Clinic observations today | HR 64 regular, BP 108/70 mmHg lying and 100/66 mmHg standing, SpO2 97% on room air, weight 88 kg (discharge weight 88 kg) |
Your tasks are to:
- Take a focused history.
- Explain the diagnosis to Mr Kowalski.
- Counsel him on his new medicines.
- 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.