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INSTRUCTIONS FOR THE DOCTOR
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Please take a history from Anthony and conduct a focused examination. Outline the most likely diagnosis and your proposed management to the observing examiner.
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Scenario
Anthony Campbell is a 46-year-old Aboriginal man who is complaining of pain in his right foot. He sprained his ankle when he was leaving a council meeting a few months ago. For the last few weeks he has experienced pain first thing in the morning, and after standing or walking for a period of time.
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The following information is on Anthony’s summary sheet at your suburban general practice:
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INSTRUCTIONS FOR THE PATIENT, ANTHONY CAMPBELL
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You are a 46-year-old Aboriginal man. You work as a finance officer for the local council. You have come to see the GP today because of a pain in your right heel. You experience sharp intense pain when you put your heel down first thing in the morning or after sitting.
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The pain eases after you have been up for a while, but it gets worse after walking any distance. It is worse when you walk around barefoot.
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The pain is getting worse, not better. You first noticed it a few weeks ago.
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A few months ago, you sprained your ankle when coming out of a council meeting late at night. Your ankle discomfort had seemed to have completely resolved, but you wonder if the two problems are connected (they turn out not to be).
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The following information is on your medical record:
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SUGGESTED APPROACH TO THE CASE
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Use open questions to explore Anthony’s ideas, concerns and expectations.
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Location of the pain—plantar fascia insertion right foot
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What’s been tried so far?
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Injury to ankle—sprain after council meeting, location of current pain suggests no connection
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Exclude other musculoskeletal/systemic symptoms1
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Request permission to examine.
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