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 40 year old female patient.
You came to A&E 1 week ago with similar pain. You were given some pain killers and you felt better so you were keen to go home.
This time the pain is much worse. The pain in worse in the upper region (you make a fist and rub it over the epigastric and RUQ region.) The pain is sharp and goes through to your back. You have been feeling nauseous and have been sick once.
For the last 6 months you have been having abdominal pain that comes in waves when you have a fatty meal, so you have cut these out of your diet.
Your last period (LMP) was 3 weeks ago
You have not been experiencing any lower urinary tract symptoms (increased frequency, burning or discharge)
Your bowels last opened this morning
You are not known to have gallstones although you have never had a scan
PMH – Tonsillectomy
SH – You live at home alone – You are a non-smoker – You drink socially
DH – You are not on any regular medications – You have no allergies
If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.