Mock Oral Examination Set 2: Case 1

Question 1

Sean is a 38-year-old tradesman working on a job in the shopping centre. He approaches you

Sean asks: “Can you give me something for my migraine please?”

A) Who is it for?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

Answer 1

A) Myself

B) Pain across the front and back of my head

C) The last two hours it has started

D) Nothing yet, I dont have anything with me which is why I came in here

E) None

F) None

G) Prochlorperazine (steel). I had it in my 20’s for a migraine once and the doctor told me not to use it again. II got a hard rash.

Question 2

Appropriate extended questions

1. Have you had this before and if so how often do you experience migraines
2. Are there any other symptoms, including fever, nausea, light sensitivity, neck stiffness, tender temples
3. Do you experience an aura/visual changes with your migraines
4. Is this migraine similar to previous episodes
5. Describe the pain (ache, throbbing, sudden or remitting, location - one sided)
6. Is pain triggered by anything, or is the pain affected by movement or laying down
7. How would you rate the pain (scale of 1-10 with 0 being no pain and 10 being worst pain)
8. In previous episodes what medication has helped
9. How long did the pain last in previous episodes
10. Has anything changed recently? Any activities?

Answer 2

1. Yes, I used to get a lot in my early 20s. I probably wasnt living too healthy back then - lots of late nights and alcohol tended to tigger attack. Might be lacking sleep as im studying late nights
2. Yes i having trouble with the light and starting to feel quite sick in the stomach – that’s how I know its a migraine. I wouldn’t mind a tablet that can help with me feeling sick as I do feel quite nauseous
3. No, my doctor has asked me about this and investigated and it appears not to be the case. I only get sensitivity to light
4. Yes, very
5. General pain across the whole front of my head and a bit in the back
6. It has been getting worse the last 2 hours, I haven’t noticed anything affecting it except the light bothering me which is common with my migraines in the past
7. 4 out of 10 and getting worse
8. I used to use maxolon (metoclopramide 10mg) on prescription for nausea which worked well, I don’t have any at home as that was years ago
9. Mostly a day, maybe a bit longer from onset symptoms to recovery time. It helps if I get into a dark room and rest which I plan to do after getting some medications from you.
10. Recent lack of sleep due to my studying. I am nearly finished with only a couple more weeks to go.

Question 3

What is the diagnosis? Explain reasoning to patient.

Answer 3

Based on the signs and symptoms you have told me, I believe you do have a migraine. The history of migraine, typical headache across front and band back of the head, nausea and light sensitivity has confirmed my diagnosis. Your recent lack of sleep due to studying may have been the trigger for this.

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

500mg paracetamol and 5mg metoclopramide (Anagraine)

• Indication: Product contains paracetamol for pain relief and metoclopramide which is a product that reduces nausea and is contained in Maxolojn which you mentioned has been helpful in the past and you are not allergic to.
• Dosage and directions: Take 1-2 tablets at first onset of migraine then repeat every 4 hours if required. Max 6 tablets in 24 hours. Be careful of other products containing paracetamol, can have 4000 of paracetamol in 24 hours.
• Adverse effects: may cause drowsiness, dizziness or headache
• Duration of treatment, time to recovery, when to refer:
  Use for duration of migraine, not more than 3 days. I will refer you to a doctor if symptoms last > 3days, if you have a fever, muscle pain/weakness, difficulty speaking, pain worse when lying down
• Lifestyle/self-care: relaxation techniques and regular breaks when studying, a regular sleep pattern is important, regular exercise, sleep in a quiet dark room.

I will give you a self-care card for migraines and a consumer medication information leaflet. Do you have any questions for me?