CANDIDATE INSTRUCTIONS

Station name: Lingham

Time allowed: 8 minutes
You are a General Practitioner.
Lingham, a 68-year old man, has been your patient for the last 10 years.
He has been on follow up with you for his hypertension, hyperlipidaemia, and non-insulin-dependent
diabetes mellitus and he is well controlled. A new and first finding today is an irregular pulse. He has
noticed some mild fatigue lately, but is otherwise asymptomatic.
Name
Age
Occupation
Hobbies

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:
:
:

Lingham
68 years old
Retired restaurant owner
Reading and playing with grandchildren

Past history
:
Hypertension on atenolol 50mg daily
Non-insulin dependent diabetes on metformin 1000mg daily
Hyperlipidaemia on atorvastatin
Appendectomy at 18 years old
Family History :
Orphaned at a young age; parents died in an accident when they were in their early 30s
Older brother died of a heart attack four years ago at the age of 69
Two children, both married Son, 42, hypertension. Daughter 38, well.
Wife is well and active
Social History :
Drinks 1 cup of coffee daily
Currently non-smoker (quit 10 years ago), but drinks alcohol daily (one glass of wine with dinner)
Lives with wife in their home in Petaling Jaya, financially comfortable

On examination:
His body mass index is 36. BP 125/80 mmHg. Pulse rate and respiratory rate normal.
Irregular pulse around 72 bpm.
Test results:
Normal thyroid function. D-dimer and cardiac biomarkers are normal.
A chest radiograph does not show infiltrates, pleural effusions, blebs, or hyperinflation.
He is generally well and all blood investigations were normal. (FBC, U&E, creatinine, CRP)
Urine toxicology negative
Tasks:
History and the ECG have been given to you.
You may take a brief history pertinent to the management plan.

1. Confirm the diagnosis with ECG

2. Explain the diagnosis to Lingham
3. Outline a patient-centered management plan for Lingham and discuss further evaluation
that may be necessary
4. Address his concerns appropriately