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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please read the following history and conduct a focused clinical examination. Tell the facilitator your findings and what initial investigations you would request.

Scenario

Joe Summers is a 67-year-old retired truck driver. He has been a patient at the practice for years but only attends to get his licence renewed. One year he went to a Pit Stop health promotion stand at the local show and he recorded a BMI of 39 kg/m2 and a waist circumference of 115 cm.

Joe has noticed over the last few months that he cannot feel so well with his hands and feet. He assumed this was a normal part of ageing but he mentioned it when he went to buy some shoes and the shop assistant was concerned and told him that he had to come to see a doctor.

The following information is on his summary sheet:

  • Past medical history

  • Nil

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Nil known

  • Family history

  • Nil known

  • Social history

  • Retired truck driver.

INSTRUCTIONS FOR THE PATIENT, JOE SUMMERS

You are a 67-year-old retired truck driver. You have been a patient at the practice for years but only attend to get your licence renewed. One year you went to a Pit Stop health promotion stand at the local show and you recorded a BMI of 39 kg/m2 and a waist circumference of 115 cm. You already knew you were overweight and drank too much so did not see the point of going back to the GP to be told off again.

You have noticed over the last few months that you cannot feel so well with your hands and feet. You also get funny tingling feelings that are irritating. You assumed this was a normal part of ageing but you mentioned it when you went to buy some shoes. The shop assistant was concerned and told you to come to see a doctor for a check-up.

The following information is on your medical record:

  • Past medical history

  • Nil

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Nil known

  • Family history

  • Nil known

  • Social history

  • Retired truck driver.

Please mimic the absence of sensation to monofilament testing, and reduced vibration sense and joint position and pain sense of your feet to the level of your ankle, and hands to your wrist. Motor function, skin, pulses and reflexes are normal.

INSTRUCTIONS FOR THE FACILITATOR

The following equipment is needed: tendon hammer, sterile neurology pins, tuning fork and 10 g monofilament.

In the interests of time, examination of the hands is not required. When the doctor asks to examine the hands, please say that the signs are the equivalent to the signs in the feet. ...

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