Mock 11

Scenario: Consultation for Trigeminal Neuralgia

Background Information:

• You are a neurologist in a hospital or a specialty clinic.
• A patient presents with severe, episodic facial pain described as electric-shock-like sensations.

Patient Profile:

• Age 55, female, reports experiencing sharp, shooting pain in the face that lasts from a few seconds to a couple of minutes.
• Pain episodes are triggered by activities such as brushing teeth, chewing, or sometimes even touching the face.

Chief Complaint:

• Intense, recurrent facial pain affecting daily activities and quality of life.

Doctor's Task:

• Perform a thorough neurological examination to rule out other causes of facial pain.
• Discuss the diagnosis of trigeminal neuralgia, including potential causes and the typical pattern of pain associated with this condition.
• Explore and explain treatment options, ranging from medication to surgical interventions.
• Address patient concerns about the chronic nature of the condition and management of pain.

Patient Prompts:

1. Pain Description and History Taking:

   • The patient describes the pain and its impact on daily life, mentioning specific triggers and the location of the pain.
   • The doctor should ask about the duration, frequency, and intensity of the pain episodes, as well as any previous treatments or medications tried.

2. Diagnosis Explanation:

   • Explain the likely involvement of the trigeminal nerve and why it causes such intense pain.
   • Discuss how trigeminal neuralgia is diagnosed primarily through patient history and clinical presentation, and the role of MRI to exclude other causes.

3. Treatment Discussion:

   • Introduce first-line treatment options, such as anticonvulsant medications like carbamazepine or gabapentin, explaining their effectiveness and potential side effects.
   • Discuss additional treatments such as surgical options (e.g., microvascular decompression or gamma knife surgery) if medications are ineffective or not tolerated.

4. Long-Term Management and Support:

   • Talk about the importance of regular follow-up to adjust treatment as needed.
   • Provide information on support groups or resources for patients with chronic pain conditions.

Clinchers:

• Stress the importance of ongoing communication between the patient and the healthcare team to effectively manage the condition.
• Reassure the patient that many treatment options are available and that a strategy will be developed that is tailored to her symptoms and response to initial treatments.

Important Points to Keep in Mind:

• Recognize and empathize with the significant impact this condition has on the patient’s quality of life.
• Use clear and concise explanations to ensure understanding, avoiding overly technical language that may confuse the patient.
• Emphasize patient education and involvement in the treatment decision-making process.

Expected from the Doctor:

• Display a thorough understanding of trigeminal neuralgia, including its pathophysiology, diagnosis, and the spectrum of treatment options.
• Demonstrate sensitivity to the patient's pain and anxiety about the condition.
• Communicate effectively, offering reassurance and clear information about prognosis and management.

This scenario provides a comprehensive assessment of the candidate's ability to manage a challenging neurological condition with significant implications for patient quality of life, focusing on diagnostic skills, treatment planning, and patient communication.