Patient Instructions
Name of Patient:
Amy Jones, aged 22
Description of the patient & instructions to simulator:
22 year old final year university student at Manchester, studying Fine Art. Feeling the
pressure at uni, finals approaching in a couple of months and lots of work to do. Feeling
stressed.
For last month has been suffering with headaches – has had approximately 4 in last month.
Does not have a headache today.
Tend to be one sided, throbbing in nature and last approximately 6 hours or so.
Doesn’t like noise or light when they are there and can feel a bit sick with them.
Sleeping normally eases them. Not related to menstrual cycle.
Thinks she might get a bit of a warning when they are starting – vision goes a bit funny for a
few minutes then headache will start but not entirely sure.
Has tried Paracetamol but not really helped. Not using regular analgesics. Not keen on
tablets.
Otherwise feels well generally. No weight loss. Feels fine between episodes. Not worse in a
morning. Vision ok between episodes. No funny turns/seizures.
No regular medications. Not on any contraception.
Knows nothing about migraine other than it is a cause of headache
LMP 2 weeks, not pregnant.
ICE –
Ideas - Concerned has a brain tumour (that's what a quick google search suggested) –
surely recurrent headaches must be caused by this.
Concerns – as above. Also worried about effect on exams if can’t get them under control.
Expectations - Would like a scan of her head, but accepting that this is not necessary if
migraine explained clearly and reassurance offered.
Also not sure if there are any other medications she can take for them as Paracetamol not
really helping.
1
Doctor’s (GP ST) Instructions
Name & age of patient
Amy Jones, 22
Summary Card
PMH: nil
DH: nil
Allergies: none known
BP/BMI/ ?smoking and alcohol hx:
None recorded.
Case Notes - Last few entries in records:
Joined practice 2 years ago, university student.
2
CSA EXAMINATION CARD
Patient Name: Amy jones
Examination findings:
BP 115/60
Slim.
Gross neurological exam normal.
Fundoscopy normal.
3
CSA Case Marking Sheet
Case Name: Amy Jones
Case Title: Migraine
Context of case

Migraines
Assessment Domain:
1.
Data-gathering, technical and assessment skills
Positive descriptors:
Negative descriptors:

Explores trigger factors (stress, food, sleep,
menstrual cycles etc)

Fails to consider differential diagnosis of
headache or explore red flags

Explores headache history and considers
red flags

Fails to ask about medications already
being used

Asks about aura symptoms

Fails to ask about triggers

Asks about other medication, ie. COCP

Fails to enquire about ICE

Asks about medication use

Fails to ask about effect on lifestyle

Asks about effect on lifestyle

Elicits ICE
Assessment Domain:
2.
Clinical Management Skills
Positive descriptors:
Negative descriptors:

Explains what a migraine is

Does not discuss analgesia

Discusses management of acute attack
with analgesic and antiemetic. Discusses
prophylaxis is a option.

Not reassuring about benign nature of
headache

Does not offer follow up

Offers reassurance
migraine

Does not safety net

Checks BP, gross neuro exam

Does not offer leaflet

Suggests keeping a diary to identify trigger

Does not examine

Offers leaflet on migraine

Safety nets and offers follow up

Suggests optician apt to check vision
about
nature
of
Assessment Domain:
3.
Interpersonal skills
Positive descriptors:
Negative descriptors:

Reassuring


Empathetic

Dismissive of concerns about brain tumour

Facilitates golden minute and listens to
concerns

Closed questions, not facilitating golden
minute

Patient centred, shared options

Doctor centred – not shared options
Not reassuring
4