Patient Instructions
Name of Patient:
Mary Berry
Description of the patient & instructions to simulator:
A 65 yr old lady with a 10 day history of headache. Recently (1 month ago) had Amlodipine
dose increased.
Wonders if it is the tablet and whether she needs to switch treatment. Has read the Pilealfet
and headache is one of the side effects.
Also feeling a bit achy and has read the Pilealfet which says statins cause muscle pain
Starts the consultation 'I wonder if I need to change my tablets doctor, as they are upsetting
me'
Nature of headache
 Particularly bad over right temple.
 Jaw aches with eating (only if asked)
 Feels generally unwell with it; tired, a little sickly and off food.
 No visual symptoms (only if asked)
 No vomiting. No positional symptoms. No neuro symptoms. (only if asked)
 Paracetamol has not really helped. Not tried much else.
Idea: It's the tablets
Concern: Worried it's the tables and her symptoms are have started to affect her baking
performce - Womens Institute annual baking competition is on thehorizon.
Expectation: Wants to get better. Would like something to help with pain.
PMH/DH: HT
Hypertension - Takes Amlodipine 10mg a day
On Atorvastatin 20mg for primary prevention.
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Doctor’s (GP ST) Instructions
Name & age of patient Mary Berry age 65
Summary Card
PMH: HT
DH: Atorvastain 20mg, Amlodipine 10mg
Allergies: None
Case Notes - Last few entries in records:
From 1 month ago
BP not at QOF target - increase Amlodipine to 10mg
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CSA EXAMINATION CARD
Patient Name: Mary Berry
Examination findings:
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Tender over temples/ temporal artery
BP 150/80
Fundoscopy normal.
Visual fields normal.
CSA Case Marking Sheet
Case Name: TA
Case Title:
Context of case
New onset temporal arteritis
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Assessment Domain:
1.
Data-gathering, technical and assessment skills
Positive descriptors:
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Asks about jaw claudication and scalp
tenderness
Asks about visual symptoms
Asks about PMR symptoms
Rule out red flags:
Symptoms of raised ICP
Appropriate exam-Including BP and
visual.
Elicits ICE
Negative descriptors:
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Does not check for visual problems.
Does not rule out red flags
Fails to examine or examination
incomplete
Fails to elicit ICE.
Assessment Domain:
2.
Clinical Management Skills
Positive descriptors:
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Explains likely diagnosis in simple way.
Explains risk of not treating (esp. re vision)
Explains initial treatment and
investigations(steroids and ESR/ CRP)
Explains need for referal for urgent biopsy
for definitive diagnosis
Explains need for aspirin and possible
bone protection as well
Safety nets re. vision
Makes a sensible plan for tests, referral
Negative descriptors:
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Does not make a diagnosis of TA
Explanation unclear.
Fails to order investigations to confirm
suspicion.
Fails to start appropriate treatment.
Safety netting not done, not appropriate or
not explained.
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and follow-up
Assessment Domain:
3.
Interpersonal skills
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Good rapport
Elicits ICE.
Establishes how headache affecting lifethrough psych social exploration
Explains diagnosis, management and
reason for safety netting in appropriate
language.
Checks for understanding.
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Doesn’t elicit ICE.
Fails to explain things clearly to patient.
Offers options inappropriately or without
heavy spinning.
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