Professional Documents
Culture Documents
AsclosetotheCSAexamaspossible
SIX CSA Cases with 4 different CSA
actors for less than 400
Individualised feedback from course facilitators & CSA actors on your performance
CANDIDATES BRIEF
Name:
Drug history:
Dr Singh: MRI scan back shows small bulge at level L4/L5. Pt complaining of ongoing back pain for
several years. Has only tried paracetamol. Keen to try other medications. Pain shoots to his left leg. No
red flags. Offered anitriptyline tablets and rw
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CSA course case CSA prep 2011
ACTORS BRIEF
Approach: You are casually dressed, and speak with a cockney accent. You have a laid back persona
History
Open history:
Your misses thinks you snore loudly everyday but you do not think you have a problem. She reports
that it wakes the baby and kids up all night
Your misses reports its been going on for several years but now for the last 1 year it is intolerable. She
has had to purchase ear plugs but feels it doesnt work. She has been shaking me or kicking me a few
times but you are completely unaware
Now she is sleeping in the next room with the kids as she cannot take it anymore. She is exhausted by
having disturbed sleep and attending to the kids who wake up all time throughout the night. She is
feeling tired all the time because of your snoring
CUE: You are getting worried about the number of nights she is spending away from your bed
You are working longer hours driving your taxi to pay for the bills with the new baby and feeling
drained and run down all the time
CUE: You have a lingering headache when you get up and can find it difficult to concentrate so you
get a quick nap at work and it disappears
You get a quick nap by parking the car on the hard shoulder on the motorway to get twenty winks
Your wife states she has had to shake you because she swears that you hold you breath when you
sleep but you thinks she is making it up as thats just daft. It happens about twice a night but shes
making it up as its nonsense
After a hard days work you go to the pub and enjoy a drink and a bit with your mates most week days.
You have a bit more on the weekend with friends watching the football
CUE: Your mood is so-so. You are a bit down how your marriage is on a downward path because of
the snoring
You do not have any fever sweats, cough or colds. You do not suffer from sore throats
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CSA course case CSA prep 2011
You do not feel colder than normal, or have dry skin or neck swellings
Ideas: You dont think you have a snoring problem (in denial) but only came because the misses
forced you.
Concerns: You are worried it is affecting your marriage and may eventually lead to a separation. You
are growing apart since she is sleeping away from your bed
Expectations: You would like some sleeping tablets so that you can go into a deeper sleep so it would
not bother your wife. Also you would like some ear plugs of your own to stop your wife whining about it
so much!
Medical history
You were told you have a back problem and find the only way to ease the pain is lying on your back
without pillows
Drug history
You take amitriptaline tablets regularly for the back and finds it works well. You take 1 tablet regularly
at night
Social history
You smoke 25 cigarettes a day since you were a teenager. It helps relaxes the nerves before you get
home
You have 2 children, Andrew aged 6months and Kevin aged 5 years. Your older child also moan about
how much you snore. He has started calling you the Noisy Gruffalo
You drink 2 pints of beer a day with friends and think that you are just under the limit when you drive
home. You drink 3 pints on the weekends with mates.
You have a small nightcap (1 shot of whisky) just before you sleep
Diet: You eat food on the go. Mostly fast food burgers, chips and bacon and eggs.
Occupation: you work as a taxi man and mainly do the airport routes so on the motorways all the time
Family history
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CSA course case CSA prep 2011
If the doctor suggests you have sleep studies then accept but suggest he is may be taking his snoring
too seriously and some sleeping tablets should do the trick
You are happy to take on board lifestyle advice given to you i.e. reduce alcohol, loose weight, stop
smoking
If doctor says he is worried that your symptoms are affecting your driving reassure the doctor and be
dismissive
If the doctor suggests it can affect your health i.e. inc risk of IHD, CVA etc then be surprised and be
attentive to the advice
You are willing to bring your wife to the next appointment, but think referrals to couples therapy or
counselling is for weak people
Snoring
EXAMINER
DATA GATHERING
Positive indicators:
Gathers information regarding presenting complaint. i.e. OSA morning headaches, apnoea, lack of
freshness in the morning
Request to perform a targeted examination i.e. examine neck (goitre), neck circumference, BP, neck
circumference etc
Negative indicators:
Fails to take a history of precipitants analgesia, sleep posture, alcohol and nightcap
INTERPERSONAL SKILLS
Positive indicators:
Develops good rapport with the patient for patient to feel comfortable to discuss health beliefs
Negative indicators:
Fails to explore the social context of the symptoms and impact on marriage or work
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CSA course case CSA prep 2011
Offers lifestyle advice re: dietary (cut down chocolates, caffeine), advise about sleep hygiene and link
of diet and sleep in making headaches worse
Advice posture advice avoid sleeping on back use pillows to ensure sleeps on one side
Advise about risk associated health problems with OSA (IHD, CVAs)
Negative indicators:
CARDS
Vitals
BP
Pulse
BMI
Weight
135 / 74
65 bpm
32
89 kg
Examination
Cardiovascular exam normal
Respiratory exam normal
2 FOR TWO COURSE ONE 2 ONE FEEDBACK - 10 CSA CASES EACH ROLEPLAYED BY MRCGP TRAINED CSA ACTORS. FOR ONLY 599
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CSA course case CSA prep 2011