Light-headedness on climbing stairs
AMC Clinical practice station

The task

You are a doctor in a general practice. Mr Rajesh Menon, aged 71, has had episodes of light-headedness when he climbs stairs. He is alone. Examine his cardiovascular system and talk aloud as you go, so that the examiner knows what you are doing and what you find. Wash your hands and assume that he is appropriately exposed. At the end, summarise your findings, give your most likely diagnosis and name two investigations. The examiner will give you any findings you ask for.

What this station tests

• Narrate your examination as you go and state the findings in clinical language.
• Pulse character, pulse pressure and carotid upstroke are as important as the murmur in aortic stenosis.
• Auscultate sitting forward in expiration to bring out aortic murmurs, and listen at the carotids.
• Symptoms with exertion, such as light-headedness, chest tightness or near-fainting, make valve disease more urgent.
• Give the examiner a summary, a most likely diagnosis and investigations, then explain it to the patient simply.

Sources for the clinical content

• healthdirect: Aortic stenosis
• Heart Foundation: What is heart valve disease?
• Austroads: Assessing Fitness to Drive
• Triple Zero emergency call information (000)

An original practice scenario with invented patients. Not an exam question.

Practise next

• Abdominal swelling and abnormal liver tests