Station - Instructions for candidate
You are an intern in the cardiology outpatient clinic of a Perth teaching hospital.
Ray Thompson, a 70-year-old retired fisherman, has atrial fibrillation that keeps coming back despite treatment. His cardiologist saw him last week and has recommended starting amiodarone; his baseline tests are printed on your sheet. He is in sinus rhythm today. The registrar has asked you to counsel him and start the medicine.
Baseline tests (this week)
| Item | Value | Reference range |
|---|---|---|
| TSH | 2.1 mIU/L | 0.4-4.0 mIU/L |
| Free T4 | 15 pmol/L | 10-20 pmol/L |
| ALT | 28 U/L | 5-40 U/L |
| ALP | 70 U/L | 30-110 U/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| INR | 2.6 | 2.0-3.0 (target on warfarin) |
| Digoxin level | 0.9 nmol/L | 0.6-1.3 nmol/L (therapeutic) |
| ECG | Sinus rhythm 72 /min; QTc 430 ms | QTc <450 ms (male) |
| Chest X-ray | Clear | - |
| Spirometry and gas transfer | Normal | - |
Your tasks are to:
- Take a focused history.
- Counsel Mr Thompson on amiodarone.
- Discuss the plan with him.
- You do NOT need to examine the patient; the examiner will give you the examination findings if you ask for them.
This is a 10-minute station, with 2 minutes of reading time.