
SFU-010 - Module 4 (Model answer)
Springpod Team
Created on September 17, 2024
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Transcript
Preparation Task (10 minutes)
Research Task (60 minutes)
Analysis Task (30 minutes)
Create Task (15 minutes)
Hear from a professional in this role to see how they might approach this task.The following pages are a detailed model answer for the work simulation on the health care industry and General Practitioner (GP).
Document and Present (20 minutes)
Reflection Task (15 minutes)
Model Answer
Simulation
PREPARAtion task
Patient Information
You should have started to think about the following:
Creating a Fictional Patient:
- Patient Name: Sarah Johnson
- Age: 45
- Gender: Female
- Occupation: Teacher
- Lifestyle: Sedentary lifestyle, rarely exercises, drinks alcohol socially, non-smoker
- Family History: Mother had Type 2 Diabetes, father had hypertension
- Current Complaints (See below):
- Fatigue for the last 2 months
- Occasional headaches, worse in the mornings
- Recent weight gain despite no significant changes in diet
- Increased thirst and urination frequency
In a female patient of childbearing age with some or all of these symptoms it is important to exclude pregnancy fairly early in the consultation. Once this possibility has been reliably excluded other possibilities may be explored. If the patient is pregnant then the possibility of gestational diabetes mellitus may also need to be considered. A potential diagnosis for a patient presenting with fatigue, morning headaches, recent unexplained weight gain, and increased thirst and urination frequency could be Type 2 Diabetes Mellitus. The combination of fatigue, increased thirst (polydipsia), and frequent urination (polyuria) are classic symptoms of elevated blood sugar levels. The weight gain, despite no dietary changes, could indicate insulin resistance, which is a hallmark of Type 2 Diabetes. Morning headaches may be related to fluctuating blood sugar levels overnight. Given the persistence of symptoms over two months, it would be important to check fasting blood glucose or HbA1c levels to confirm or rule out this diagnosis.Additionally, other possibilities like hypothyroidism (associated with fatigue and weight gain) could be considered, but the increased thirst and urination strongly suggest a metabolic issue like diabetes. Some of these symptoms also raise the possibility of arginine vasopressin disorder (formerly known as diabetes insipidus), brain tumour, inflammation or infection of the urinary tract or chronic analgesic abuse. Although Type 2 Diabetes may well be the working diagnosis in this case, other less likely possibilities in the differential diagnosis could have significant health implications and will therefore need to be considered and excluded.
Simulation
research task
Simulated Consultation
History Taking
Key Information Gathered
Physical Examination
Researching Procedures
Simulation
Analysis Task
Type 2 Diabetes Mellitus:Justification: The symptoms of increased thirst, frequent urination, and recent weight gain, combined with a family history of diabetes, strongly suggest Type 2 Diabetes. Morning headaches could result from fluctuating blood glucose levels.Hypertension (High Blood Pressure):Justification: Morning headaches and a family history of hypertension raise suspicion of high blood pressure. If confirmed by blood pressure measurement, this could explain her symptoms, especially headaches.Obesity:Justification: Recent weight gain and a sedentary lifestyle suggest obesity, which can exacerbate other health conditions like diabetes and hypertension. BMI calculation would likely indicate this diagnosis.
Hypothyroidism:Justification: Fatigue, weight gain, and low energy could also indicate hypothyroidism, though the absence of cold intolerance or other thyroid-specific symptoms makes this less likely.Brain tumourJustification: New onset of waking headaches in this age group can be an indicator of raised intracranial pressure. If there is papilloedema present on retinal examination, a prompt neurological referral would be indicated.Arginine vasopressin disorderJustification: Lethargy, Polyuria and polydipsia are features of arginine vasopressin disorder, although weight gain is less likely. Dilute urine with no excess glucose is usually found.
Potential Diagnoses and Justifications:Based on Sarah’s history and the simulated physical examination, I formed the following potential diagnoses:
Simulation
Create Task
Tests to Confirm Diagnosis:
- Fasting Blood Glucose and HbA1c: To confirm or rule out diabetes.
- Blood Pressure Monitoring: To check for persistent hypertension. Additional tests such as ECG and chest x-ray will be needed if hypertension is confirmed.
- Thyroid Function Test: To rule out hypothyroidism.
- A water deprivation test and blood antidiuretic hormone levels to exclude arginine vasopressin disorder.
- Lipid Profile: To assess cholesterol levels, especially considering weight gain and potential cardiovascular risks.
Lifestyle Modifications:
- Encourage Sarah to adopt a balanced diet rich in whole grains, fruits, and vegetables. Suggest reducing processed sugars and increasing physical activity (e.g., walking 30 minutes daily).
- Discuss gradual weight loss targets.
- Recommend keeping a food and exercise journal to track progress.
- If diagnosed with Type 2 Diabetes: Metformin as a first-line treatment to improve insulin sensitivity.
- If diagnosed with Hypertension: Consider low-dose ACE inhibitor (e.g., Lisinopril) to manage blood pressure.
- Schedule follow-up consultations to monitor blood glucose, HbA1c, weight, blood pressure, fundoscopy, foot pulses and sensation testing. Encourage regular visits every 3-6 months to reassess lifestyle changes and medication efficacy.
- Endocrinologist: If diabetes, hypothyroidism or arginine vasopressin disorder is confirmed for specialised care.
- Dietitian/Nutritionist: To provide tailored nutritional advice for weight management and glucose control.
- Neurology referral if papilloedema or other neurological changes noted
Management Plan for Sarah Johnson:
Treatment Options:
Simulation
Document and Present
Medical Report for Sarah Johnson:
Assessment:
- Suspected Type 2 Diabetes Mellitus
- Mild Hypertension
- Obesity
- Rule out Hypothyroidism or arginine vasopressin disorder
- Tests: Fasting Blood Glucose, HbA1c, Thyroid Function Test, consider checking blood antidiuretic hormone levels. Blood Pressure Monitoring.
- Treatment Plan: Encourage lifestyle modifications (diet and exercise), initiate Metformin if diabetes is confirmed, and consider antihypertensives for high blood pressure.
- Referrals: Endocrinologist and Dietitian as necessary.
- Follow-Up: Schedule reassessment in one month or earlier if necessary
Consultation Notes:
- History: 2-month history of fatigue, recent weight gain, increased thirst and urination. No significant dizziness or vision changes. Possibility of pregnancy excluded.
- Physical Examination: Simulated BMI >30 (obese), normal heart and lung sounds, mild hypertension noted. No papilloedema on retinal inspection.
I created a formal medical report in Google Docs, formatted as follows:
Patient Name: Sarah JohnsonAge: 45Gender: FemaleOccupation: TeacherLifestyle: Sedentary, social alcohol use, non-smokerFamily History: Type 2 Diabetes (mother), Hypertension (father)Presenting Complaint: Fatigue, morning headaches, increased thirst, and weight gain.
Simulation
Reflection Task
Journal Reflection:
Strengths and Challanges
Future Applications
Reflect on the Process:
This simulation was incredibly useful in simulating a real-world GP consultation and health assessment. I particularly appreciated the step-by-step process of gathering patient information and forming a management plan based on both subjective (history) and objective (physical examination) data.
Strengths:I felt confident in taking a detailed patient history and identifying relevant physical exams based on Sarah’s complaints.I was able to generate a comprehensive list of potential diagnoses that accounted for multiple possible conditions.Challenges:Interpreting the data to narrow down potential diagnoses was challenging, particularly when balancing multiple conditions with overlapping symptoms, such as diabetes and hypertension.Deciding which physical examinations to prioritise required careful thought to ensure I didn’t overlook important signs.
In the future, I aim to refine my ability to interpret complex symptom patterns more efficiently. I also plan to focus on improving my knowledge of diagnostic tests, ensuring that I recommend the most appropriate and timely investigations.
Simulation
Expected outcome
By the end of this activity, I have gained practical experience in gathering and analysing marketing intelligence data. I have also developed strong skills in making data-driven business decisions, improving my analytical abilities, and presenting my findings in a professional manner. This will be particularly beneficial for my career as a Business Intelligence Analyst.
Expected Outcome
BACK
I researched standard procedures for each examination and potential findings:
- Elevated blood pressure could indicate hypertension.
- BMI over 30 suggests obesity, which could link to her symptoms.
- Cardiovascular and neurological exams would help rule out more serious causes of headaches (e.g., increased intracranial pressure).
- Dip testing urine and finger prick testing are not diagnostic of diabetes but may help to guide evaluation. Urine dip testing for pregnancy would help to clarify this possibility.
- Fatigue that is constant, not relieved by rest
- Headaches mainly in the morning, mild, dull in nature
- Weight gain of 10 pounds over the last two months
- Thirst has increased, drinking 8-10 glasses of water per day
- No significant dizziness or vision issues reported
- The patient has excluded the possibility of pregnancy
- The patient is not using any medications for pain relief
Using Google Forms, I created a structured format to record Sarah’s patient information and complaints. I started with open-ended questions:
- “Can you describe your fatigue?”
- “When did the headaches begin, and how have they changed over time?”
- “Have you noticed any other changes in your health recently?”
- “How much water are you drinking daily?” (to understand the increased thirst)
- “Is there a time of day when the fatigue worsens?”
- “Do you have any vision changes or dizziness?”
- “Is there any possibility that you might be pregnant?”
- “Are you using any pain relief medications on a regular basis?”
Based on her symptoms, I identified the necessary physical examinations to simulate:
- General Inspection: Observing for signs of weight gain, endocrine disorders or dehydration (e.g., dry mouth, skin turgor).
- Blood Pressure Measurement: To check for hypertension.
- Body Mass Index (BMI): Calculation based on height and weight to assess obesity risk.
- Cardiovascular Exam: Listening to heart sounds for abnormalities, assessing peripheral pulses and circulation
- Neurological Exam: Basic test for vision and reflexes, inspection of the retinal fundii with an ophthalmoscope especially given the morning headaches.
- Dip testing of a urine sample for excess glucose. NOT diagnostic of Type 2 Diabetes, but would be a supporting factor in the differential diagnosis. Dip testing may also help in determining the presence of infection or inflammation in the urinary tract. If there is any doubt about the possibility of pregnancy, then a urine pregnancy test may also be done (with consent) to clarify this.
- A finger prick blood glucose level is similarly not diagnostic, but may help to provide additional guidance.