Location for this role play: General Practice

• The student has been asked to take a history from a simulated patient
• Please kindly follow the script to simulate the consultation
• You will not be expected to undertake an examination
• Please answer in the negative to any specific questions about your condition where the answer is not outlined in the script

Symptoms first noticed approximately 12 months ago and have gradually worsened.

You have noticed a cramping pain in your left calf. It does not occur at rest – only after walking. You have also noticed some pain in the left leg at night-time.

• Used to be able to walk to local shops (≈ 200 m) with no problems.
• Around 12 months ago cramps started in the left calf.
• In the past 3 months the distance you can walk without stopping has reduced considerably – now stop after about 50 metres due to left calf cramping.
• Pain improves after resting for about 5 minutes.
• Pain is in the left calf (not right); no significant pain in thigh, buttocks or hips.

Over the past 3 months you have started to experience pain at night – a more severe aching pain in the left foot and toes, only noticed while lying flat in bed.

At least a couple of times a week you have to get up out of bed because of the pain. This helps considerably – you cannot understand why, as during the day walking seems to make the pain worse.

• Some redness around the toes when sat down – longstanding, not new.
• No tingling or numbness in feet/toes.
• No swelling or redness in the calf.
• No chest pain or significant breathlessness (though you take things slowly these days).

• Ideas: Initially thought the cramps were related to getting older or a calf muscle strain. The worsening and new night pain prompted the GP visit.
• Concerns: Worried why it is worsening and now occurring at night. Finding it very difficult to do shopping (does not drive; used to walk to shops). Now relies on neighbours and friends and does not want to burden them.
• Expectations: Want a diagnosis and treatment. If it is a calf muscle problem, perhaps a scan and specialist review.

• Hypertension and raised cholesterol for several years – on medication
• Type 2 diabetes diagnosed two years ago – on a tablet
• Last saw practice nurse two months ago: BP and blood results were OK; most of the appointment discussed smoking

• Amlodipine and ramipril (blood pressure)
• Atorvastatin (cholesterol)
• Metformin (Type 2 diabetes)
• No known drug allergies

• Mother died of breast cancer in her 70s
• Father died from a heart attack in his 70s
• One sister who has diabetes but is otherwise well

• Lived with partner for 40 years (never married). Partner died suddenly three years ago from a heart attack.
• No children. Supported by sister and close friends but feels lonely at times.
• Used to visit the local pub of an evening; now less mobile and stays in more, increasing loneliness.
• Worried about shopping – relies on neighbours/friends; fears becoming a burden.
• Smoking: 20 cigarettes a day since teenage years. Multiple previous quit attempts (patches, gum, vaping) unsuccessful. Recognises it is harmful but does not feel ready to stop currently (“one of my few comforts”).
• Retired 10 years ago (most recently Citizens Advice Bureau).
• Alcohol: drinks “in moderation” and “socially” (cannot quantify units).

If the student asks about any other symptoms aside from those listed in the script above, please reply in the negative.

Useful reference: NICE CKS – Intermittent Claudication

Clinical Skills Foundation Course · Phase 1 Term 3 · PVS Role Plays · Case last revised July 2026

• Top differential diagnosis: Intermittent claudication (underlying peripheral arterial disease) with nocturnal/rest pain indicating potentially severe PAD.
• Risk factors present: Smoking (most powerful predictor of PAD), diabetes, hypertension, raised cholesterol, older age.
• Investigations: Refer for vascular assessment (urgency depending on symptoms/examination). ABPI ratios, duplex ultrasound.
• Key history points: Claudication distance; nocturnal/rest pain (relieved by hanging leg out of bed / getting up).
• Possible examination findings: Reduced/absent distal pulses, dependent rubor, hair loss, arterial ulcers, femoral/aortic bruits.
• Management principles: CVD risk reduction (smoking cessation, antiplatelet, statin, optimise diabetic control); supervised exercise programme; consider angioplasty/bypass; consider naftidrofuryl oxalate if exercise has not helped and patient prefers to avoid intervention.