Station - Instructions for candidate
You are a medical student on placement in a general practice.
Rosalia Bortolin is a 68-year-old woman attending your general practice with a weeping wound above her left ankle that has been present for six months.
Results provided:
Ankle-brachial pressure index
| Item | Value | Reference range |
|---|---|---|
| Right ankle-brachial pressure index | 1.08 | 0.9-1.3 |
| Left ankle-brachial pressure index | 1.04 | 0.9-1.3 |
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 121 g/L | 115-155 g/L |
| White cell count | 7.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| CRP | 4 mg/L | <5 mg/L |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.3 mmol/L | 3.5-5.2 mmol/L |
| Creatinine | 78 umol/L | 45-90 umol/L |
| eGFR | 68 mL/min/1.73 m2 | >60 mL/min/1.73 m2 |
| HbA1c | 39 mmol/mol | 20-41 mmol/mol |
Your tasks are to:
- Take a focused history of the presenting wound and relevant background.
- Perform a focused examination of the left lower-leg wound and peripheral vascular system. Describe to the examiner what you would look for or do; the relevant findings will be provided to you.
- Request appropriate investigations. Results will be provided by the examiner if appropriately indicated.
- State the most likely diagnosis and two to four differentials, with brief justification.
- Outline the initial management plan, including treatment, referral and safety-netting.
- You do NOT need to summarise your history and examination findings to the examiner before stating your diagnosis.
- Please verbalise your examination and request investigations to the examiner; findings and results will be provided when appropriately requested.
- You do not need to write a prescription or perform a wound dressing in this station.
This is a 10-minute station, with 2 minutes of reading time.