Patient Instructions

Name of Patient:
Lorraine White

Description of the patient & instructions to simulator:

Loraine is 25, normally fit and well working as a GP receptionist.
Her mum has been found to have CKD3b and has just been diagnosed as having polycystic
kidney disease.
Lorraine is in a stable relationship and is wanting to start a family and is worried as her mum
has told her that her consultant mentioned that polycystic kidneys 'run in families' and her
children should be 'checked out'.
Lorraine is worried she might get polycystic kidney disease and that her children might also
be affected
She would like to know what it is, the chances of her having it and the chances of her
children having it and whether you can be tested for it.
No one else in the family is known to have it
She has no urinary, abdominal or gynae symptoms or problems
No previous medical problems
4 units of alcohol per week and a non smoker
She would be happy with an explanation, PILealfet, USS +/-blood tests and or referral to a
specialist

Doctors (GP ST) Instructions

Name & age of patient

Lorraine White
Summary Card
PMH: Nil
DH: Nil
Allergies:None
BP/BMI/ ?smoking and alcohol hx:

Case Notes - Last few entries in records:

2010 flu like symptoms, advised re rest, fluids and paracetamol

CSA EXAMINATION CARD

Patient Name: Lorraine White

Examination findings:
BP 120/60
Urine dip negative for blood, glucose and protein
Abdo exam no enlarged kidneys felt, no masses

CSA Case Marking Sheet

Case Name: Lorraine White

Case Title:ADPKD

Context of case

Mum has polycystic kidney disease,

Lorraine worried as wanting to start a
family

Assessment Domain:
1.
Data-gathering, technical and assessment skills
Positive descriptors:

Negative descriptors:

Explores Ideas (knows little about it other

than it runs in families), Concerns (do I
have it? Might my children have it?),
Expectations
(information,
testing,
advice)

Does not identify ICE especially concerns

re he plans to have children

Does not ask about urinary symptoms e.g.

haematuria

FH explored

Does not ask about abdominal symptoms

Asks re abdo pain, abdo swelling, hx of

renal stones (renal stone hx in 1 in 5
patients with ADPKD!), haematuria?

FH not explored

Inadequate examination

No urine dip test

Appropriate exam (BP, urine dip test and

abdo exam)

Assessment Domain:
2.
Clinical Management Skills
Positive descriptors:

Comprehensible explanation of the

conditions and inheritance

ICE addressed

Offer of blood test (kidney function), ACR,

USS

Offer of a Pileaflet with contents

explained

Review after results

Consideration of the merits of genetic

counselling referral

Negative descriptors:

Incomprehensible explanation

Aspects of ICE not addressed

Inappropriate tests or no tests

Lack of signposting to website or PIlealfet

Inadequate safetynetting

Safetynetting

Assessment Domain:
3.
Interpersonal skills
Positive descriptors:

Negative descriptors:

Empathetic, rapport built

Concerns explored

Shared management plan achieved

Understanding explored

Cues missed
Concerns not handled or handled
unsympathetically
Paternalistic approach to management