General Practice
CANDIDATE INSTRUCTIONS
You are a resident year 1 doctor working in the GP Clinic. A 60-year-old gentleman presents with a headache for 2 months. He also notices that he has palpitations and occasional blurry vision.
Take a focused patient's history.
At 7 minutes, the examiner will stop you to ask you some questions.
2 Minutes Reading Time
10 Minutes Station Time
Total 12 Minutes
EXAMINER INSTRUCTIONS
Timing Instructions: At 7 minutes, stop the candidate and ask the following questions:
Question 1: What is your provisional diagnosis? Give 2 differential diagnoses with reasons
Answer 1:
Provisional Diagnosis:
Essential Hypertension (Note: Candidate should ask questions that rule out other causes)
Differential Diagnosis:
Pheochromocytoma
Conn's Syndrome
Cushing's Syndrome
Hyperthyroidism
Question 2: What is the next appropriate step for this patient? (3 marks)
Answer 2:
Perform vital signs (includes heart rate, blood pressure, respiratory rate, SpO2, temperature), and relevant systemic examination.
Perform a fundoscopy
Advise on HBPM (home blood pressure monitoring)
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Essential Hypertension
PATIENT INSTRUCTIONS
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Name: Benedict Cumberbatch
Age: 60 Years Old
Date of Birth: 1st February 1964
Location: GP Clinic
Occupation: Senior Sales Manager
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“I have been having headaches for the past 2 months”.
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Site : Whole head (if questioned, around my head)
Onset : 2 months ago, first time
Character : Throbbing and aching
Radiating : Non-radiating
Associated symptoms
Palpitations, intermittent, comes with the headache
Occasional blurry vision, no obstruction of view, temporary
Timing : Intermittent, last for a maximum of 5 minutes
Exacerbating : Stress
Alleviating factors : Pain relieved with OTC paracetamol. Temporary relief.
Severity : 7/10
Red flag symptoms :
No fever, neck stiffness, nausea, vomiting (▲meningitis)
No thunderclap headache, worst headache of his life, No sudden weakness (▲TIA)
TRO secondary causes of hypertension!
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Otherwise, NO fever, lost of weight, loss of appetite (constitutional symptoms)
No signs and symptoms suggesting secondary hypertension
Pheochromocytoma : Hot flushes
Hyperaldosteronism : Muscle weakness (d/t hypokalemia)
Hyperthyroidism : Sweaty, tremors, anxiety, sensitive to heat, exophthalmos,
weight lossCushing syndrome : Weight gain, buffalo neck, central obesity, moon face,
abdominal striae
Previous episodes: Never experienced this before.
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Ideas: “I don’t know!”
Expectations: “Please help me doctor?”
Concerns: “Do I have something serious?”
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NO chest pain,
NO vomiting, diarrhea, abdominal pain
NO weakness of upper limbs and lower limbs.
Normal urinary flow and bowel habits.
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Previous hospital admissions: None
Previous surgeries: None
Medical conditions: Diabetes and High Cholesterol
Medications:
Tab Metformin 500g BD, compliant
Tab Simvastatin 5mg ON, compliant
Over the counters:
Paracetamol for the headache. Only temporary relief.
Allergies:
None.
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Father and mother have high blood pressure. Diagnosed in their 40s. Compliant with medications. Siblings are otherwise healthy and well.
Married with one child. Otherwise healthy and well.
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Smoking: Does not smoke
Alcohol: Does not drink alcohol
Recreational drugs: Never
Diet: Always eat takeaway food
Exercise: Sometimes jogging
Ill contacts: No one around me was recently ill
Home: Lives with wife and children
Active Daily Living: Work in the city centre
Occupation: Senior Sales Manager. Finds it stressful to keep up with the younger peers.
MARK SCHEME
Introduction
Chief Complaint
History of Presenting Complaint
Systems Review
Past Medical History
Drug History
Family History
Social History
Questions
Patient Scores
Enter Your Score Here: /27
SCORE GUIDE
Pass: 18-27
Borderline Pass: 12 – 17
Fail: 0-11
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