Doctor’s Instructions:
You are a junior doctor in General Practice. Anna Holland is a 63-year-old female with underlying essential hypertension for the past 3 years. She has come in today for a routine review. Assess her BP control, advise accordingly based on the recent investigations below, and address any concerns she might have.
Blood pressure: 155/98 mmHg
QRISK: 12%
Renal profile normal.
Patient History:
Anna Holland, 67-year-old female, a retired accountant.
You come in today for a review of your hypertension which was diagnosed incidentally about 3 years ago. You missed your last 2 review appointments because you are always busy caring for your husband, Tom who has Alzheimer’s.
You do not check your blood pressure at home, but you remember the last time you came in it was above 150. You were initially started on a medication called amlodipine that gave you unpleasant palpitations. Following that, you switched to a medication called enalapril about 1 year ago. You try your best to take your medicine every day but there are certainly days where you forget which you think is natural since you are always busy at home with Tom.
You confess that the real reason you wanted to come in today wasn’t to discuss your blood pressure but because you were worried about this new cough you’ve developed. The cough started about 6 months ago. It came on gradually and you are coughing a lot more now. It is mostly dry and not particularly worse at a given time of day. You have never coughed up any blood.
No other respiratory symptoms: wheezing, shortness of breath, chest pain. No constitutional symptoms: fever, weight loss, loss of appetite, night sweats.
Ideas, Concerns, Expectations:
You wonder if the cough could just be a smoker’s cough. You worry if this could be something serious like cancer. You are hoping to find out the cause and if it will ever resolve.
Past Medical History:
No past medical history.
Drug History:
Enalapril 10mg OD
Over the counter multi-vitamins
No known drug allergies
Family History:
Your mum had cataracts.
Your dad had type 2 diabetes and high blood pressure.
They both died of old age.
Social History:
You live with your husband, Tom. He has Alzheimer’s and you have been his primary carer for as long as you can remember.
Your only daughter moved to Australia a couple of years ago.
You used to smoke a pack a day for 30 years before your HTN diagnosis but cut down to half a pack ever since. You cannot give it up entirely as it is the only thing that relieves your stress from being a carer.
You do not consume alcohol and you are very proud of this. You feel it’s okay to smoke since you don’t drink; after all, everybody needs some form of stress relief. You and your husband eat a lot of packed microwave foods as that is the easiest for you. You know it’s not healthy, but it saves time and you don’t know where to start to eat healthier.
Marking Scheme: