Geriatrics Station 1

Setting:

You are a junior doctor working in ED. This patient has presented with sudden onset weakness.

Name: Scott James

Tasks:

1. Take a history from the patient.

2. Give your preferred diagnosis to the examiner.

3. Inform the patient of their diagnosis and answer any questions.

4. Give your initial management plan to the examiner.

You are not required to examine the patient.

Briefing

Diagnosis: Stroke
In this scenario we are asking you to role play a patient attending the emergency department following sudden onset weakness.

For this scenario, your details are:
Patient Name: Scott James (age: 76)

Appearance and Behaviour

You have no speach or cognitive symptoms. Aim to look worried when asked about your concerns.

Opening statement

“Well doctor, I was eating my dinner and suddenly I couldn’t lift my fork up”

Information to Give Freely

You had sat down for dinner this evening and had been eating normally for about 10 minutes when you tried to lift your fork and you couldn’t. You tried to get up from the table and found that your leg wasn’t moving either

Presenting Complaint

Symptom and Site - Weakness in the LEFT arm and leg
Onset - came on over seconds 2 hours ago
Character - dense and complete left sided weakness
Radiation - Did it spread anywhere? - No, it stayed in arms and legs
Timing - constant with no change
Exacerbating/relieving facotrs - No relief, you came to hospital as soon as you could so didn’t get a chance to try much to help.
Severity - Are you able to move the affected limbs at all? - No, you’ve completely lost movement in both the LEFT arm and LEFT leg.
Any previous head or neck trauma? - No
Any history of falls? - No

Past Medical and Drug History

No episodes like this before
Diabetes Type 2 (on Metformin)
Hypertension (on Ramipril and Amlodipine)
High Cholesterol (on Simvastatin)
No Allergies

Family History

Your father had a stroke at 68 but recovered well. Nil else of note.

Social History

Smoking - 30 a day for 35 years (quit 5 years ago)
Alcohol - 2 glasses of red wine everyday because "i've heard it's good for your heart"
Home -

Who's at home? - you, your wife, and your dog

Type of house? - Bungalow

Stairs - None at home but you can manage them when out and about. You are NOT breathless when walking up stairs.

ADLs - You can get around easily at home and like gardening outside and taking the dog for walks. You can self care well.

Mobilisation - no need for walking aids.

Job - used to be a joiner, now retired.
Baseline - You feel well in yourself both mentally and physically. Sometimes it’s difficult to keep on track of all the medications you take. Your wife and yourself help each other as needed.

Systemic Review

Headaches - No

Loss of consciousness - No

Visual changes - No

Speech changes/difficulty swallowing - No

Neck pain - No

Sensory loss - No

Difficulty coordinating movements - No

Palpitations/chest pain - No

Ideas / Concerns / Expectation

Ideas - “Could it be a stroke, it seems similar to what my dad had”
Concerns - “That I won’t be able to do the things I enjoy afterwards”
Expectations - “Could someone contact my wife and check that she’s okay and let her know what’s happening”

Discussion and Questions

The candidate will inform you that you are having a stroke. After they have explained the situation you ask...

Do you think i'll make a full recovery? - If they explain it's difficult to tell at the moment and reasure you that they will do more tests then accept this answer.

If the candidate informs you that you'll make a full recovery ask - "how long exactly will recovery take?"