Station - Instructions for candidate
You are a junior doctor working in a general practice in Perth.
Carmela Caruso, a 56-year-old primary school teacher, had a raised blood pressure reading at a routine check a month ago. She has since had a second clinic reading, a week of home monitoring with a validated cuff, bloods and an ECG, all printed below. She has come back to discuss the results. The practice nurse has measured her blood pressure again today.
Blood pressure today (practice nurse, seated, average of two)
156/94 mmHg; weight 78 kg, height 164 cm, BMI 29 kg/m2, waist 94 cm
Blood pressure record, bloods and ECG
| Item | Value | Reference range |
|---|---|---|
| Clinic blood pressure, visit 1 (4 weeks ago) | 158/96 mmHg | <140/90 mmHg |
| Clinic blood pressure, visit 2 (2 weeks ago) | 156/94 mmHg | <140/90 mmHg |
| Home blood pressure, 7-day average (28 readings, validated upper-arm cuff) | 152/94 mmHg | <135/85 mmHg |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Creatinine | 70 umol/L | 45-90 umol/L |
| eGFR | 88 mL/min/1.73m2 | >60 mL/min/1.73m2 |
| Urine albumin-creatinine ratio | 1.2 mg/mmol | <3.5 mg/mmol |
| Fasting glucose | 5.4 mmol/L | 3.5-5.4 mmol/L |
| Total cholesterol | 6.1 mmol/L | <5.5 mmol/L |
| LDL cholesterol | 3.9 mmol/L | <2.0 mmol/L |
| HDL cholesterol | 1.4 mmol/L | >1.0 mmol/L |
| Triglycerides | 1.6 mmol/L | <2.0 mmol/L |
| ECG | Sinus rhythm 74 /min; normal axis; no left ventricular hypertrophy; normal | Normal |
Non-smoker. No diabetes. Australian CVD risk calculator: approximately 7% risk of a cardiovascular event over 5 years (intermediate risk).
Your tasks are to:
- Take a focused history.
- Explain the results and what they mean to Mrs Caruso.
- Counsel her on starting perindopril.
- You do NOT need to examine the patient.
- You do NOT need to summarise your findings to the examiner.
- You do not need to write a prescription in this station.
This is a 10-minute station, with 2 minutes of reading time.