• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 on call for medicine

Patient: John is a 32 year old stockbroker who has presented to hospital with abdominal pain

Task:
– Take a focused history from the patient
– After 6 minutes you will be asked a series of questions by the examiner.
– Answer any questions that the patient may have

Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You are a 32 year old stockbroker who works for a large multi-national company.

You have been having upper abdominal pain intermittently for the past 3 weeks. Over the past 24 hours it has been substantially worse, you have been vomited once about 6 hours ago and you noticed some dark red bits mixed in with the vomit, you have not had any vomiting since. If directly asked your stools have been darker. Usually you get the pain after eating and sometimes at night. You have noticed the pain is substantially worse after drinking alcohol.

If asked your job is very stressful and you have been noticing the pressure recently with rounds of redundancies. You have hurt your knee recently when playing tennis, you have been taking ibuprofen over the counter for this and it has worked well. Your job is very stressful and so each day after work you go to the pub and have 3 pints of beer.

You have no weight loss or reduced appetite.

PMH

  • Had tonsils removed when younger
  • Recently hurt knee in sporting accident, just taken pain relief over the counter

DH

  • No regular medications
  • No drug allergies

SH

  • You smoke 1 cigarette at work if you are stressed, but you do not smoke all the time
  • You drink 3 pints of beer during the week and more on the weekend if you are being social
  • You live in a flat at home alone

FH

  • Your dad died of a heart attack

ICEF

  • You have no idea what is going on
  • You are worried you aren’t going to be able to go to work
  • You just want a pill to help this all go away

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / Year / grade
Clarifies who they are talking to
Asks patient for preferred name


SOCRATES
Site
Onset
Character
Radiation
Exacerbating factors
Relieving factors
Timing
Severity


Additional GI symptoms
Dysphagia
Appetite
Nausea and vomiting
Altered bowel habit
Jaundice
Fever
Weight loss


Focused history
Use of NSAIDs
Use of steroids
Taking any anticoagulants
Job stress


PMH Past Medical History
Candidate asks specifically about previous ulcers, gastritis, reflux
Had tonsils removed when younger
Recently hurt knee in sporting accident, just taken pain relief over the counter


DH Drug History
No regular medications
No drug allergies


SH Social History
You smoke 1 cigarette at work if you are stressed, but you do not smoke all the time
You drink 3 pints of beer during the week and more on the weekend if you are being social
You live in a flat at home alone


FH Family History
Your dad died of a heart attack


ICEF ICEF
Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions


Question Given the history, what are your differentials?
Gastritis
Peptic ulcer disease
GORD
Other appropriate answer


Question Given the history what initial investigations would you like to do?
Bloods = FBC, U&E, LFTs,
Coagulation
Amylase
Group and save
ECG
Erect CXR


Question What further investigations would be appropriate in this patient?
Endoscopy
Colonoscopy
Helicobacter pylori testing



Score