Student information You are ut inter on a medical ward Mis CA apreviously fit and independent 79 year old was admitted to your unit 2 weeks ago with aright hemiplegia. S/he was hypertensive and is in chronic AP. No other causes or risk factors for stoke were identified. An infarct was confiamed on CT scan. While s/he was in hospital se had an echocardiogram which revealed R and L atsal diameters atthe upper limit of normal and normal let ventricular function. ihe has been ‘commenced on perindopril and indapamide and her blood pressure is now under good contol. She i also on aspirin 100mg/cay. She remains in AP ata ventricular rate of between 90 and 120 beats per mincte.S¢hehas made a good recovery from her stroke and is now ready for discharge. ‘TASK: Discuss with him/her management in relation to his/her atrial fibrillationOSCE PRACTICE INSTRUCTIONS FORROLE PLAYER * You are-79 yeats old snd are almost ready for discharge rom: hosptel. You were admitted 2 weeks ago with weakress down jour right sie tat the doctors se was due to stoke. The weakness has now virually resolved and you feel ready 1o reum te your home. Sisce yeu fave been i hospital the doctors have told you that you have igh blood pressure and have sinvtod you on treatment forthis. They told you tht good control of your blood pressure was important to help reduce yoar risk of further stroke, You fel ha itis very importat to ninimise the ssh of another stroke. Four years ago you hada sumach ule The doctrs gave you tentont with 2 anti well as an ant-ulcer drug to get Sof tho germ in your oma ht caused the leet. Yor fave nd ne symptoms snc, You are gens in good heath anddon'oen need tos & ‘doctor You do oscasionally get some jint aches end pens and if they ave bad you take ‘regular parecetamol or occasionally a Nurofen ifthe paracetnnol does net wouk. The only ‘ther medications you are taking re Covers] Pls for your blood pressure anda baby aupiin, Both of these have been started since you sere to opt “The student (intem) hes told you ‘ha heiShe wants to come today and have talk toyou about ‘your imegulr beat bestPRACTICE OSCE MARKING SHEET studert information ‘You ares inter on medal wad ‘Mus CA aprovouly asd independent 79 sear oli was adie to yur ui? werk go wth ight Imipiaia She war iypotensve and incon AF Note: anes ot rk factors for stoke were Feet Aninar wae condimed on CT sci. Wile she was e hsp she had in excep ich teveles Rao Lata caneter ot he oper Emit ofr hd sural le vensicuae fen She ba ees ‘eumenced o peindopling indagamge anc her ood peseie ro det god sono he i alan Spiro lOOmgy. She remain it AF ata vercular ae ef beten SOand 10 bea per mine Shes nnd a god uuvey fete ate aia mo es for charge ‘TASK: Discuss with hinver management in relation to his/her atrial fibrillation Sore Mark: Grieton aa ane cepted ae sangre | bled Ela craved svoke risk AF-S) advection by Beombosis propyl eo ° 1 2 i 2 [Diseuses rate contol vs iti conzol a ‘Desides on appropiate teatmet for at convolp Blocker © 1 | vempari mark, éigoxis 0.5 mask o 1 2 scutes benefits warfsn vs asin Tor Bromboss wage $0 ~— eta 0 1 2 re Pat ag cli lrsk fictors for bleing ler, liver dense °. ‘Discusses potntial for drug interactions on wariin 05 ‘Nes fr regula INR monitoring — “Asks patients bout undemtanding offfo and views about | 0 OS