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CSA scenarios with REAL CSA actors ‘As close to the CSA exam as possible’ Book

CSA scenarios with REAL CSA actors

‘As close to the CSA exam as possible’

Book your place on the course for £350

possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA
possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA

4 CSA Cases with 4 different CSA actors for less than £400

Individualised feedback from course facilitators & CSA actors on your performance

CSA course cases

CANDIDATE’S BRIEF

Patient medical records

Name:

Robert Learner (49 year old)

Past medical history: Hypertension

Drug history:

Ramipril 5mg od

Zopiclone 7.5mg prn (7 tablets)

Last consultation (6 weeks ago)

Patient reports being quite stressed. Works as businessman for an international company and trying to close important deal. Also moving house. Requested for some sleeping tablets. Promises to take time off work to recuperate. Short course of zopiclone offered

CSA scenarios with REAL CSA actors ‘As close to the CSA exam as possible’ Book

CSA scenarios with REAL CSA actors

‘As close to the CSA exam as possible’

Book your place on the course for £350

possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA
possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA

4 CSA Cases with 4 different CSA actors for less than £400

Individualised feedback from course facilitators & CSA actors on your performance

CSA course cases – Chest pain

ACTOR’S BRIEF

Background: You are Robert Learner a 49 year old businessman

Approach: You are dressed professionally, politely spoken and well mannered

Opening statement: “Hi doctor. Thank you for seeing me but I am worried about this chest pain I have been suffering with.’

History

Open history:

You have had this pain in your chest for the last 7 days

You feel it in the middle of your chest

Initially it was a niggling pain and now it is quite painful and got you worried enough to see the doctor

It is not linked with meals and happens any time during the day

Its now affecting your ability to focus at work and is getting worse

CUE: You do not think it is down to stress as you have recently travelled to Spain 4 weeks ago on holiday which you enjoyed

Reveal history if asked:

Ideas – You are worried that it could be a pulmonary embolism as you spoke to your friend who was diagnosed with one. You typed your symptoms into the computer and had a fright as you read that people who travel on planes are at risk of pulmonary embolisms (blood clot in the lung)

Concerns – You are worried that you have only recently travelled to Spain 4 weeks ago by plane and think it could be related. The journey was for 3 hours and you were sitting in economy class. You also had some calf pain 2 weeks later

Expectations – You would like to know if the pain you re suffering is caused by a blood clot in your lung

There is no shortness of breath or coughing up blood. It does not move anywhere

The pain is sharp and worse when you breath in

It varies in intensity and can come on any time. Typically last for 1 hour at a time

You are not sure if it is related to movement

Paracetamol has not helped the pain

You have had some calf pain 2 weeks ago but you had been doing some gardening at the time

CSA scenarios with REAL CSA actors ‘As close to the CSA exam as possible’ Book

CSA scenarios with REAL CSA actors

‘As close to the CSA exam as possible’

Book your place on the course for £350

possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA
possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA

4 CSA Cases with 4 different CSA actors for less than £400

Individualised feedback from course facilitators & CSA actors on your performance

If the doctor has been thorough in history taking admit that you have been doing several odd jobs around the house that you have always been promising the wife to do since you moved in.

You had tried to put a small chandelier in the front room. You had been in the garden as well as trying to fix it up as it was left in a state

Medical history

Hypertension – you always take your medication as prescribed and eat a healthy low salt diet

Nil else – i.e. diabetes

Drug history

Ramipril one tablet a day with good compliance

You were on short course of sleeping tablets that you finished. They helped at the time and you have no recent sleep disturbances

Nil else

Social history

You smoke 3 cigarettes a day but plan to give up

You work as a businessman selling electronic goods to retail shops. Recently you had a large order from Currys for your PCs which you secured

You enjoy your work but not under any stress especially as you went abroad recently

Family history

Dad died of heart attack aged 75

No family history of DVT or PEs

If the doctor suspects it is a blood clot in the lung (PE), appear anxious and worried. Ask if you are going to die

If the doctor reassures you it is musculoskeletal pain then enquire about the risk of your recent flight and calf pain you experienced

You are happy to accept taking ibuprofen tablets only if the doctor gives you 100% reassurance that it is not a pulmonary embolism

You enquire as to what you should do if you travel on a plane again to reduce your risk of a PE and whether you should be wearing special leg stockings in future on plane journeys

CSA scenarios with REAL CSA actors ‘As close to the CSA exam as possible’ Book

CSA scenarios with REAL CSA actors

‘As close to the CSA exam as possible’

Book your place on the course for £350

possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA
possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA

4 CSA Cases with 4 different CSA actors for less than £400

Individualised feedback from course facilitators & CSA actors on your performance

CSA course case – Chest pain

EXAMINER

DATA GATHERING

Positive indicators:

Gathers information and clarifies problem. A focussed history will ascertain probability of MSK pain than PE

Elicits history of calf pain – but linked to gardening

Ascertain other risk factors of PE – smoking history, immobility, FH of DVTs or PEs etc

Negative indicators:

Fails to identify based on probabilities a likely diagnosis of MSK

Fails to elicit risk factors for PE i.e. travel abroad and history calf pain

INTERPERSONAL SKILLS

Positive indicators:

Explores ICE (concern that symptoms are caused by PE due to ‘recent travel abroad’)

Develops rapport with the patient

Negative indicators:

Fails to reassure the patient regarding their symptoms

CLINICAL MANAGEMENT SKILLS:

Positive indicators:

Inform the patient of your working diagnosis and offer reassurance

Advised to trial analgesia

Offers advice regarding measure to reduce the risk of PEs when travelling i.e. Fluid intake on plane, exercises, avoid alcohol, compression stockings

Negative indicators:

Falsely reassure patient of symptoms and increases anxiety by suggesting symptoms are a PE

Fails to offer analgesia

Fails to give advice re travelling and PE’s

CSA scenarios with REAL CSA actors ‘As close to the CSA exam as possible’ Book

CSA scenarios with REAL CSA actors

‘As close to the CSA exam as possible’

Book your place on the course for £350

possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA
possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA

4 CSA Cases with 4 different CSA actors for less than £400

Individualised feedback from course facilitators & CSA actors on your performance

CSA course case – Chest pain

CARDS

 

Vitals

Examination

Examination if requested

BP

132 / 74 68 bpm

Cardiovascular and respiratory examination normal No calf pain or swelling noted

Chest wall tender to palpate on left 5 th rib

Pulse

BMI

23

 

Sats

99%

 
CSA scenarios with REAL CSA actors ‘As close to the CSA exam as possible’ Book

CSA scenarios with REAL CSA actors

‘As close to the CSA exam as possible’

Book your place on the course for £350

possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA
possible’ Book your place on the course for £350 4 CSA Cases with 4 different CSA

4 CSA Cases with 4 different CSA actors for less than £400

Individualised feedback from course facilitators & CSA actors on your performance

CSA course case – Chest pain

MX NOTES

Pulmonary Embolism

Pulmonary embolus is a common problem and may affect a person of any age.

The embolus occurs when the arteries supplying the lungs are blocked by a blood clot usually resulting from a deep vein thrombosis; but fat, air, and tumour tissue can be implicated as well.

Symptoms include, sudden onset sharp ‘stabbing’ chest pain, worsened by deep breathing and coughing. The patient may also have haemoptysis, tachycardia and shortness of breath at rest.

Risk factors for pulmonary embolus include prolonged bed rest or immobility, oral contraceptive use, surgery, child birth, cancer, stroke, recent surgery and fractures of the hips or femur.

Facts about Venous Thromboembolism & flying

• Evidence suggests increased risk of DVT with flights >4 hours duration

• Risk includes other long journeys such as coach journey, train or car i.e. immobility

• Patients with hip or knee replacement should not travel on long journey flights for up to 3months

• Patients with a plaster cast should not fly for up to 1-2 days (depending on length of journey)

• Compression stockings can reduce the risk of DVTs (recommended in moderate risk patients). LMWH should be reserved for high risk patients. No supportive evidence for aspirin

• If a patient notes that they have painful, swollen legs or short of breath post flight they should seek urgent medical attentions

Risk and Management of Venous Thromboembolism & flying

Based upon British Heart Foundation (Sept 2010)

Low risk

no PMH or risk factors

Advice - Drink plenty of (non-alcohol) fluids. Avoid caffeine, sleeping tablets

Keep mobile: if seated do stretches every 30 min. Press the ball of the foot against the foot rest to increase blood flow to leg. Have breaks and walk up and down aisle

Medium risk

PMH DVT/PE, recent surgery, clotting disorders, pregnancy, or BMI>30

Advice – Above including compression stockings (graduated class 2)

High risk

PMH DVT + risk factors i.e. cancer, recent surgery

Advice - Above including LMWH before the flight and on next day