Instructions
You are a medical student on placement in general practice. Your next patient is Lorenza Pagano, 67, a retired librarian, who has felt dizzy and unsteady on her feet for six weeks, since she came home from hospital.
Perform a full examination
Outline to the examiner:
- Your findings
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
- You do not need to take a history
- Please verbalise your examination; findings will be provided on request
- You do not need to discuss treatment, only investigations
Discharge summary (six weeks ago)
Ten days in hospital with E. coli urosepsis and an acute kidney injury, which recovered before discharge. Treated with IV antibiotics for 10 days.
History taken by the GP today
Unsteady since discharge, worse in the dark and on uneven ground. Everything 'bounces' when she walks or rides in the car. No spinning, nausea, ringing in the ears, hearing change, headache or double vision. No new medicines, no diabetes, a glass of wine a week.