CANDIDATE INSTRUCTIONS

You are a resident year 1 doctor working in the GP Clinic. A 46-year-old lady presents with a blurry vision for 2 months. She also notices a numbing sensation in her legs.  

  1. Take a focused patient's history. 

  2. 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?

Answer 1: Newly diagnosed Diabetes Mellitus

Question 2: What are the relevant examinations you will be conducting for this patient?

Answer 2

  • Vital Signs: Heart Rate, Respiratory Rate, Blood Pressure, SpO2, Temperature, BMI

  • Random Blood Sugar (RBS)

  • Cardiovascular Examination

  • Diabetic Foot Examination

  • Sensory Examination

Question 3: What are the non-pharmacological interventions that the patient can do?

Answer 3:

  • Diet: Change to a low-carbohydrate diet, high in protein and fibre

  • Exercise: Moderate aerobic exercise for 30 minutes, 5 days a week

  • Loose Weight

  • Avoid sugary food and drinks

Question 4: What does HbA1c tell about the patient?

Answer 4: HbA1c is the amount of glucose in the patient's blood for the past recent 3 months

  • Type 2 Diabetes Mellitus

PATIENT INSTRUCTIONS

  • Name: Deborah Jones

    Age: 46 Years Old

    Date of Birth: 1st March 1978

    Location: GP Clinic

    Occupation: Housewife

  • I have been having difficulty seeing for the past 2 months”.

    • Site : Both Eyes

    • Onset : 2 months ago, first time

    • Character : Blurry

    • Radiating : N/A

    • Associated symptoms

      • Polyuria: "I've been using the loo more often than usual recently"

      • Nocturia: "I tend to use the loo at night"

      • Polydipsia: "I notice I have become more thirsty recently"

      • Paresthesia: "I've been having some tingling and numbness over my hands and feet"

      • "I've noticed my urine is more frothy and bubbly!"

    • Timing : Persistent

    • Exacerbating : N/A

    • Alleviating factors : N/A

    • Severity : N/A

    • Red flag symptoms :

      • NO eye pain, red eye (▲ Acute Closed Angle Glaucoma)

      • NO fever, red eye, watery discharge (▲ Acute Conjunctivitis)

      • NO headache, sudden weakness of the body (▲ TIA)

    • Otherwise, NO fever, lost of weight, loss of appetite (constitutional symptoms) 

    • Previous episodes: Never experienced this before.

    • Ideas: “Do I have diabetes?"

    • Expectations: “Please help me doctor?”

    • Concerns: “Am I going to be blind forever??”

    • NO fever, recent infections, cough, flu, chest pain,

    • NO abdominal pain, vomiting, diarrhea

    • NO weakness of upper limbs and lower limbs.

    • Normal bowel habits.

  • Previous hospital admissions: None

    Previous surgeries: None

    Medical conditions: None

    Medications:

    • None

    Over the counters:

    • None.

    Allergies:

    • Amoxicillin.

  • Father and mother has diabetes. Diagnosed in their 40s. Compliant with medications. Siblings are otherwise healthy and well. 

    Married with two children. Otherwise healthy and well.

    • Smoking: Does not smoke

    • Alcohol: Does not drink alcohol

    • Recreational drugs: Never

    • Diet: Always eat a lot of bread and rice

    • Exercise: Never.

    • Ill contacts: No one around me was recently ill

    • Home: Lives with husband and children

    • Active Daily Living: Takes care of grandchildren

    • Occupation: Housewife

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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