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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please examine Mrs Cosgrove, who presents with hip pain. You are not required to take any further history. Please tell the examiner your examination findings, your differential diagnosis and initial plans for management.

Scenario

Sarah Cosgrove is 71 years old and has come to see you complaining of pain in her right hip. This pain has been gradually getting worse over the past few years. The pain is beginning to interfere with her daily activities and she gets some stiffness after she has rested. She still cycles to do her shopping.

Mrs Cosgrove has pain in both first metacarpophalangeal joints, both knees and her neck.

The following information is on her summary sheet:

  • Past medical history

  • Appendicectomy as a child

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Cervical screening test and breast screen

  • Normal one year ago

  • Social history

  • Married

  • Two children, one overseas

  • Alcohol—two standard drinks per week

  • Non-smoker.

INSTRUCTIONS FOR THE PATIENT, SARAH COSGROVE

You are a 71-year-old retired personal assistant. You have always been active and still cycle to do your shopping. You have come to see the GP today because of pain in your right hip. This pain has been gradually getting worse over the past few years. Your symptoms now interfere with your daily activities and you experience some stiffness after resting.

You also have pain in both first metacarpophalangeal joints, both knees and your neck.

Both your older brothers have had hip replacements because of osteoarthritis. You suspect this is what you have but you are concerned about possible surgery because one brother had serious postoperative complications and nearly died.

Clinical examination findings

On examination you will indicate that the pain is felt centrally in the right inguinal canal. Please demonstrate minimal tenderness on palpation over the greater trochanter of the right hip and reduced hip movement on abduction, internal rotation and extension. When the doctor asks to examine your back, other hip and knees please report that this is not necessary.

The following information is on your medical record:

  • Past medical history

  • Appendicectomy as a child

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Cervical screen test and breast screen

  • Normal one year ago

  • Social history

  • Married

  • Two children, one overseas

  • Alcohol—two standard drinks per week

  • Non-smoker.

INFORMATION FOR THE FACILITATOR

Alternative scenario

The doctor is told that Mrs Cosgrove has osteoarthritis of the right hip. They are required to focus on management. The emphasis would be on ensuring Mrs Cosgrove understands the problem and chooses with the doctor the options for treatment. The doctor should notice hesitation when surgery is discussed and explore the rationale for her concern.

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