🚀 Early Bird Tickets for our Pharmacy OSCE Conference — Register Now for £7 →
  Search Files
Register

Scenarios

Info Capsules

Videos

All Files
Home
Account Settings
osce toolbox
Register



GP Interaction 7

View all notes

This feature is unavailable on mobile device 😔
note-icon
All products and content are protected and may not be duplicated, reproduced, or redistributed without written permission.

Report a problem
 Scenarios

GP Interaction 7
By Shakthi Nandakumar   .   February 12, 2024 .   Last reviewed:   24/09/24 .    




Summary

In this scenario, the student is tasked with answering a doctor's questions about starting a breastfeeding patient on medication to treat hyperthyroidism. 

 

Please ensure that this scenario and mark scheme align with the most up-to-date UK NICE guidelines and the BNF when using it for your OSCE assessment. 

 
A student pharmacist and an actor playing the role of a trainee doctor are required. 

Revision Topics
Be aware, this may reveal any answers!

Hyperthyroidism  

Pregnancy 

Beta Blockers 

Lab Results

Student Instructions

You are a pharmacist working in a community pharmacy. A local trainee GP has come to the pharmacy seeking advice on prescribing medication for hyperthyroidism. 

You are expected to gather relevant information and respond to their questions appropriately. 

 

To do  

  1. Gather essential patient details, including medical history, current medications, allergies, and lifestyle factors relevant to the scenario 

  1. Offer clear, evidence-based advice to the GP on potential next steps, including management options or further diagnostic testing. 

 

You have 8 minutes.
You have access to the BNF. 

Actor AI 🤖 (Beta)
Actor Instructions

Your name is Dr. Jun Devan (Joon, Dee-vahn). 

You are a trainee GP.  

 

Opening statement: “Hi, my name is Doctor Devan.I have some questions about a patient who a specialist has recommended me to commence on carbimazole, but who is currently breastfeeding." 

 

Patient details: 

Provide this information when prompted. 

  • Name: Jessica Arden (Jess-ih-kuh, Ar-den) 

  • Age: 29 

  • Gender:  

    • “Female.” 

  • Symptoms:  

    • “She has had a 1-month history of palpitations, hair loss, diarrhoea, and anxiety.” 

  • Drug history: 

    • “Not on any long-term prescription medication.” 

    • “She does take paracetamol when required for migraines.” 

    • "No known allergies"

  • Past medical history: 

    • “4-year history of Migraines.” 

  • Information: 

    • “Currently breastfeeds a 6-month-old baby.” 

    • “Mentioned is hoping to try for another baby soon.” 

    • “She is trying to conceive within the following 6 months” 

 

Test results  

“I have her test results with me too." – provide these 3 minutes in if not prompted.

 

Thyroid Function Test Results Patient Results Reference Range Levels
TSH 0.3mU/L 0.5-5.7mU/L Low
fT4 180nanomol/L 70-140nanomol/L High 
fT3 200pmol/L 60-180pmol/L High

 

Questions: 

  1. “Can I give carbimazole to a breast-feeding patient?” 

 

ONLY ask questions 2-3 if the student asks about whether the patient is at risk of pregnancy/needs contraception when taking carbimazole. (any mention of contraindication during pregnancy). 

  1. “She is planning for another pregnancy so what medication can I give her?" 

  1. “Will she need any monitoring on that?” 

  1. “The specialist recommended I should prescribe a beta-blocker in patients with hyperthyroidism, do you know why?” 

  1. “Which beta-blocker would you recommend and what dose?” 

Mark Scheme

 

 Introduction
0 / 3
Introduce yourself with an appropriate greeting. 
+1
Confirms patient details: Name and age.
+1
Confirms Prescriber Identity
+1
Medical History 
0 / 9
Confirms patient's past medical history.  
+1
Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies. 
+1
Ask about the patient’s symptoms
+1
Discusses patient's test results: Low TSH, Elevated fT4, Elevated fT3.
+1
Asks about the indication for carbimazole.
+1
Screens for current pregnancy and confirms the patient is breastfeeding.
+1
Checks for any allergies and confirms reaction.  
+1
Confirms diagnosis and indication for hyperthyroidism treatment using acquired knowledge of symptoms and test results.
+1
Mentions contraindication of carbimazole in pregnancy OR requirement of contraception.
+1
Question 1: 
0 / 1
Can I give carbimazole to a breast-feeding patient?
Yes, however, the lowest effective dose should be used and the neonate, will need monitoring for development and thyroid levels.
+1
Question 2: 
0 / 1
She is planning for another pregnancy so what medication can I give her?
States Propylthiouracil at the lowest effective dose as a safer alternative. 
+1
Question 3: 
0 / 2
Will she need any monitoring on that?
Hepatotoxicity
+1
Thyroid Levels
+1
Question 4: 
0 / 1
The specialist recommended I should prescribe a beta-blocker in patients with hyperthyroidism, do you know why?
Appropriate explanation of the use of beta-blocker adjuncts.
+1
Beta blockers decrease sympathetic hyperactivity (for symptoms such as palpitations, tachycardia, tremulousness, anxiety, and heat intolerance). (alternatively: propranolol partially blocks the peripheral conversion of T4 to T3)
Question 5: 
0 / 2
Which beta-blocker would you recommend and what dose?
Propranolol – Most used.
+1
10–40 mg 3–4 times a day
+1
Accept Metoprolol or Nadolol at an accurate dose as per BNF 2024.
Communication 
0 / 6
Uses appropriate language for the person and situation.
+1
Uses volume, tone, pace, and emphasis appropriately, and gives time to ask questions.
+1
Knowledge and understanding of the topic are apparent.
+1
The conversation is structured and flows well.
+1
Concludes well, helping with further questions.
+1
The student did not say anything that could harm the patient  
+1
This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.
Time Management
0 / 1
Completed the scenario in time and achieved 70% of marks
+1
 

Any criteria marked in red must be met to pass this station. 




red flag Red Flags missed: 0

Total Score
0/
Skills
communication 0/7
professionalism 0/3
information gathering 0/7
diagnostic reasoning 0/1
patient safety 0/12
knowledge 0/8
Time Management 0/1


Please login to save your score.
Referral Criteria


Referral Criteria for Hyperthyroidism:

Emergency A&E Referral: 

  • Thyroid Storm:High fever, severe agitation, rapid heart rate, or confusion requires immediate attention. 

  • Severe Cardiac Issues:Sudden chest pain or severe shortness of breath, indicating potential heart attack or failure. 

  • Neurological Symptoms:Confusion, seizures, or unconsciousness may point to a severe complication. 

 

Urgent GP Appointment Referral: 

  • Heart Symptoms:Palpitations, chest pain, shortness of breath, or irregular heartbeats. These could suggest complications like atrial fibrillation. 

  • Eye Problems:Eye pain, redness, swelling, bulging eyes, double vision, or vision changes could indicate Graves' ophthalmopathy. 

  • Pregnancy:If pregnant or planning pregnancy with symptoms of hyperthyroidism, due to risks like preterm birth or pre-eclampsia. 

  • Severe Symptoms:Rapid weight loss, significant tremors, or extreme fatigue suggesting uncontrolled hyperthyroidism. 

References

NHS, 2024.Overactive thyroid (hyperthyroidism) - Complications. Available at:https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/complications/[Accessed 1 September 2024]. 

 

NICE, 2024.Hyperthyroidism. [online] Available at:https://cks.nice.org.uk/topics/hyperthyroidism/[Accessed 24 September 2024]. 

 

Comments



You need to be logged in with an active subscription to post a comment




This website uses cookies to ensure you get the best experience
Learn more