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.