Simulated Patient Brief — AMARI (VTE / DVT)
Location: General Practice. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Amari
- Age
- 75 years
- Opening statement
- “My right calf has swollen up overnight after my hip replacement two weeks ago.”
Two weeks ago you had a planned right total hip replacement for severe osteoarthritis. The operation went as planned; you were discharged on day 4. You have tried the physio exercises and to stay mobile, but still have considerable post-op pain.
Immediately after surgery the whole right leg was somewhat swollen compared with the left — you were told to expect this. Yesterday you awoke to find the right calf much more swollen. The calf has been significantly painful for 24 hours (8/10 persistent throbbing), separate from the dull, movement-related groin/hip ache. Your partner says the calf feels warmer; if asked, it looks generally red rather than a localised patch.
You called the GP yesterday afternoon; first appointment was this morning. You discussed A&E but were worried about waits and the journey, so waited overnight.
Response to questions
- Open questions: describe the operation, expected swelling, and the sudden calf change as above.
- If asked specifically: GA; compression stockings; hospital blood-thinning injections into the stomach; aspirin to take at home for 6 weeks. Slightly short of breath. Sharp pain in the right side of the chest, worse on coughing or deep breath, not worse with exertion. You are not worried about the chest symptoms — you attribute them to worry about the leg. No previous blood clots.
Ideas: Worried something has gone wrong after the operation. Not sure of the diagnosis but feel something must have gone wrong.
Concerns: Worried this could be infection (pain, swelling, redness) and that you might need urgent antibiotics. Allergic to penicillin, so worried about limited options.
Expectations: A diagnosis and treatment, including the possibility of a non-penicillin antibiotic.
- Severe osteoarthritis of the hip — otherwise quite fit and well for your age
- No history of blood clots if asked
- Aspirin 150 mg daily for 6 weeks post-op (clot prevention)
- Omeprazole short-term with the aspirin
- Co-codamol 30/500 — 2 tablets every 6 hours since the operation; constipating, so you have not sought stronger analgesia
- Allergic to penicillin — rash as a teenager; no lip/tongue swelling or anaphylaxis
- Mother died of a stroke in her 70s; father of stomach cancer in his 60s
- Two brothers on blood-pressure medication; otherwise well
- No family history of blood clots if asked
Married 40 years; partner in good health and a strong support. Three grown-up daughters living away. Housing-association flat. Retired 7 years ago; last job was a school driver. Never smoked; no alcohol. Used to enjoy walking holidays in the Peak District; hoping for a “new start” after the hip replacement.
Systems review: reply in the negative to any other symptoms.