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INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history and conduct an appropriate examination. Outline the most likely diagnosis and negotiate a management plan with Mr Schmidt.

Scenario

Mr Eric Schmidt is a retired farmer aged 76. He is used to hard physical work and is worried that he can no longer walk very far. He did not want to bother the doctor about it but finally let his daughter make an appointment when she saw him struggling at the weekend.

The following information is on his summary sheet:

  • Past medical history

  • Deep laceration to right arm from farm machinery 1984

  • Declined to attend recent men’s health screening held at surgery

  • Medication

  • Nil recorded

  • Allergies

  • Nil recorded

  • Immunisations

  • Nil recorded

  • Family history

  • Father died of myocardial infarction aged 50

  • Mother died of ‘old age’

  • Social history

  • Farmer

  • Married with two children.

INSTRUCTIONS FOR THE PATIENT, ERIC SCHMIDT

You are a retired farmer aged 76. You are used to hard physical work and are worried because you can no longer walk very far. You did not want to bother the doctor about it but finally let your daughter make an appointment when she saw you struggling at the weekend.

You get a cramp-like pain in your right leg after walking a certain distance. Once you stop and rest for five minutes you can continue on further. Currently you can get to the first paddock, about 500 m, but then have to lean on the gate for a while until the pain in your leg goes away.

You do not have any nocturnal pain or any other symptoms of cardiovascular disease.

You roll your own cigarettes and get through about 20 a day. You drink two or three cans of beer at the weekend. You have considered giving up smoking and would like advice from the doctor on how to do this, particularly if the doctor thinks that this will improve your leg pain.

INSTRUCTIONS FOR THE FACILITATOR

The candidate should perform a cardiovascular examination.

Clinical examination findings

On examination, there are absent popliteal, posterior tibial and dorsalis pedis pulses on the right leg. There are no bruits. All other findings are within the normal range.

The following information is on your summary sheet:

  • Past medical history

  • Deep laceration to right arm from farm machinery 1984

  • Declined to attend recent men’s health screening held at surgery

  • Medication

  • Nil recorded

  • Allergies

  • Nil recorded

  • Immunisations

  • Nil recorded

  • Family history

  • Father died of myocardial infarction aged 50

  • Mother died of ‘old age’

  • Social history

  • Farmer

  • Married with two children.

SUGGESTED APPROACH TO THE CASE

Establish rapport

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