Station - Instructions for candidate
You are a final-year medical student on placement in a general practice in Perth. Your supervising GP has asked you to see this patient first and to bring him a plan.
Graham Whitfield, 66, saw the practice nurse last week for tiredness and had blood tests taken. He has come back for the results, which are on the sheet below. He has not yet been told what they show.
| Practice record | Hypertension on perindopril 5 mg daily. Aspirin 100 mg daily (started by a previous GP 10 years ago). Ex-smoker. No previous bowel investigations. Family history recorded: father - bowel malignancy aged 72. |
|---|---|
| Observations (practice nurse, last week) | HR 88 /min regular, BP 134/82 mmHg, RR 16 /min, SpO2 97% on room air, T 36.6 degrees C, weight 84 kg (86 kg three months ago) |
| Blood results (last week) | Haemoglobin 98 g/L (130-180), MCV 71 fL (80-100), MCH 22 pg (27-32), RDW 18% (11-15), WCC 7.2, platelets 410 (150-400). Ferritin 9 micrograms/L (30-300), transferrin saturation 8% (20-50), CRP 3 mg/L (under 5). |
Your tasks are to:
- Take a focused history.
- Request any further investigations you need, and explain to the examiner what the results on your sheet show. The examiner will provide results where appropriate.
- State your most likely diagnosis and the differential diagnoses to the examiner.
- Outline your initial management plan, including any referral, and explain it to Mr Whitfield.
- You do NOT need to examine the patient; the nurse found no abnormal findings apart from pallor.
- You do NOT need to summarise the history to the examiner.
- State drug, dose and route where relevant, and the urgency of any referral.
This is a 10-minute station, with 2 minutes of reading time.