GP CCE Cases · neurological-presentations
Resolved weakness in the waiting room — CCE clinical encounter
CCE-style clinical encounter: a 63-year-old man describes 10 minutes of right-arm clumsiness that resolved before arrival. The candidate must resist reassurance, exclude hypoglycaemia, score ABCD2 correctly, start aspirin after haemorrhage exclusion logic, and arrange same-day specialist assessment.
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Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 63-year-old accountant attends because his wife 'made him'. This morning his right hand became clumsy typing for about ten minutes, then normal. He feels fine, jokes about 'a pinched nerve', drives himself to work daily, and takes no regular medication. BP 156/94 mmHg; glucose 6.2 mmol/L; neurologically normal on examination.
Objectives
- Take a focused event history that establishes focality, duration, and full resolution — and recognise this as a probable TIA. [1]
- Exclude the mimic at the bedside: glucose checked and documented. [1]
- Score ABCD2 transparently and explain what it does and does not mean. [1]
- Initiate management consistent with haemorrhage-exclusion logic (aspirin pending urgent imaging/specialist pathway) and arrange specialist assessment within 24 hours. [2]
- Deliver driving advice (group 1: one month off) and safety-net for recurrence. [1]
References3ShowHide
- [1]Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack Lancet, 2007.PMID 17258668
- [2]Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study) Lancet, 2007.PMID 17928046
- [3]Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack (CHANCE) N Engl J Med, 2013.PMID 23803136