Notes

{
"key": "Case1",
"category": "Care of Acutely Unwell People",
"caseTitle": "Care of Acutely Unwell People Case 1",
"caseIsDone": false,
"isPremiumCase": false,
"caseLocked": false,
"description": "Lorem ipsum dolor sit amet",
"instructions": "Lorem ipsum dolor sit amet",
"doctorView": {
"description": "You are a locum GP doing telephone triage at 5pm, calling back Ben’s father",
"profile": {
"firstName": "Ben",
"lastName": "Johnson",
"age": "3 years and 4 months",
"address": "86 Nando Lane, London"
},
"fullDetails": {
"entrySection": {
"text": "Graham Johnson is worried about Ben, who has developed a high temperature. You have called the surgery and there are no appointments left and you’re waiting for a phone call back."
},
"items": [
{
"itemTitle": "Previous consultations in last 12 months:",
"details": [
"Tonsillitis 7 months ago.&endl;Plan: antibiotic treatment",
"Viral tonsillitis 11 months ago.&endl;Plan: support management, no antibiotics required."
]
},
{
"itemTitle": "Past medical history",
"details": [
"Born at term",
"Birthweight 3.9kg 75th Centile",
"Head circumference 35cm 50th centile"
]
},
{
"itemTitle": "Medication history",
"details": [
"Nil",
"Regular"
]
},
{
"itemTitle": "Allergies",
"details": [
"Nil known"
]
}
]
}
},
"patientView": {
"description": "Graham Johnson is worried about Ben, who has developed a high temperature. You have called the surgery and there are no appointments left and you’re waiting for a phone call back.",
"profile": {
"firstName": "Ben",
"lastName": "Johnson",
"age": "3 years and 4 months",
"gender": "Male"
},
"fullDetails": {
"entrySection": {
"text": "Hi doctor I’m really worried about Ben as his temperature has been really high. Last time it was this high he needed antibiotics for tonsillitis, so I think if he had some antibiotics that would do the trick."
},
"items": [
{
"itemTitle": "Background",
"details": [
"You are an accountant and working from home today because your son is unwell and he is off sick from nursery.",
"You have a 12 month old who you are also looking after at home today, and the child minder has gone home now.",
"Your wife has stayed at work late since you are working from home and looking after the children.",
"You live 3 miles from the practice in a rural area."
]
},
{
"itemTitle": "Symptoms 1 – can provide on open questioning",
"details": [
"High temperature more than 48 hours",
"38.5 measured at home this morning. Last checked 15 mins ago 39.5",
"Given paracetamol 1 hour ago.",
"You think it’s probably tonsillitis as similar symptoms to last time.",
"Not clearly opening mouth."
]
},
{
"itemTitle": "Symptoms 2",
"details": [
"Flushed cheeks today and in the past 2 hours has developed a rash on his tummy.",
"The rash is blanching, you have checked it.",
"Tongue looks a little red.",
"Has not slept well overnight.",
"Usually his happy self, however today clingy and sat on sofa most of the day, just watching TV.",
"Looks quite tired and exhausted."
]
},
{
"itemTitle": "Symptoms 3",
"details": [
"Not eating or drinking much.",
"No lunch, but had a pot of yoghurt and orange juice for lunch.",
"Coco pops for breakfast.",
"Vomited once this morning after coco pops",
"He has done three wees today, and the last was 3 hours ago.",
"He’s not had much to drink over the past 3 hours."
]
},
{
"itemTitle": "Past medical History & development",
"details": [
"Bacterial tonsillitis twice in the past 12 months",
"No developmental concerns",
"Has been growing well",
"Goes to nursery usually"
]
},
{
"itemTitle": "Medication",
"details": [
"Paracetamol",
"Ibuprofen"
]
},
{
"itemTitle": "Allergies",
"details": [
"Nil known"
]
},
{
"itemTitle": "Family history",
"details": [
"Nil significant"
]
},
{
"itemTitle": "Social history",
"details": [
"Lives with parents Graham and Lisa",
"Last two times for tonsillitis the child minder brought the child to the surgery and picked up the prescription.",
"You have never been to the doctor’s before as your child minder normally takes them when there are issues as you or wife usually at work.",
"Your wife has told you to make the call.",
"Your wife is a barrister and works long hours."
]
},
{
"itemTitle": "ICE",
"details": [
"Want to make sure gets the right treatment before his wife comes home as she’s going to be exhausted after a long day at work.",
"Although you can’t definitely see in the back of the mouth, you know it’s tonsillitis.",
"Just some antibiotics will do the trick.",
"Don’t want to waste anyone’s time as you’ve got work to do, and the doctor must be really busy if they have no appointments."
]
},
{
"itemTitle": "Examination findings",
"details": [
"If asks to speak to child, he is currently having a nap on the sofa.",
"When asking him where it’s hurting before he pointed to his throat and tummy.",
"No neck stiffness",
"No sensitivity to light",
"No cough",
"No breathing difficulty",
"Not opened bowels today"
]
},
{
"itemTitle": "Your behaviour depends on the doctors decisions:",
"details": [
"You think that it’s just a waste of time, and it would be much easier if the doctor just prescribes you the antibiotics.",
"You don’t want to come over because it means you have to get both your children ready including the 12 month old, and then you have to drive 5 miles there in rush hour traffic.",
"If the doctor explains why you need to come in you listen but you would prefer can they come after the surgery for a home visit.",
"If the doctor explains clearly, firmly but nicely why he/she can’t do a home visit then you reluctantly agree to bring Ben in.",
"If the doctor says he will come for a home visit you gladly accept.",
"If the doctor is rude to you when asking you to come in then you flat refuse to come in because you wouldn’t want to see that doctor anyway. Say you will wait to see what happens and if he gets more unwell will take him to A&E."
]
}
]
}
},
"examinerView": {
"description": "Use this page to mark the student on the following criteria:",
"sections": [
{
"title": "Data Gathering ",
"criteria": [
{
"isCorrect": false,
"question": "Thorough history of Ben’s symptoms"
},
{
"isCorrect": false,
"question": "Relevant red flags including: lethargy, rash & flushed cheeks, persistent high temperature, eating and drinking less and wet nappies. Check for neck stiffness and photophobia."
},
{
"isCorrect": false,
"question": "Full past medical history, medication, allergies"
},
{
"isCorrect": false,
"question": "Understands the father’s current social situation with the children and difficulties getting to the surgery"
},
{
"isCorrect": false,
"question": "ICE gained"
},
{
"isCorrect": false,
"question": "Explores patient's father thoughts about starting antibiotics"
}
]
},
{
"title": "Clinical Management",
"criteria": [
{
"isCorrect": false,
"question": "Offers to see Ben today in clinic and achieves this agreement with father."
},
{
"isCorrect": false,
"question": "Negotiates in an understanding and empathetic way to encourage father to come in."
},
{
"isCorrect": false,
"question": "Picks up red flags and explains them clearly to father in context of him not wanting to come in"
},
{
"isCorrect": false,
"question": "Gives some advice about what can do right now including increasing fluid intake, checking for certain things such as neck stiffness, non-blanching rash & photophobia."
},
{
"isCorrect": false,
"question": "Adequate safety netting"
},
{
"isCorrect": false,
"question": "Able to think that is able to see patient in view of clinical need despite there not being appointments."
},
{
"isCorrect": false,
"question": "Patient father may not agree to come in, however is able to adequately safety net and give appropriate advice e.g. ibuprofen, fluid intake, temperature monitoring and checking alertness. If not improving then OOH would be sensible."
}
]
},
{
"title": "Interpersonal Skills",
"criteria": [
{
"isCorrect": false,
"question": "Empathetic and able to negotiate with father to bring patient in"
},
{
"isCorrect": false,
"question": "Explained why it would be advantageous to see in surgery"
},
{
"isCorrect": false,
"question": "Be understanding to the patients ICE."
}
]
}
]
}
}