Location: You are an FY1 in A&E
Patient: Mr Daniel Davies, 36 years old, has attended with severe upper abdominal pain
– 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 36 year old man named Daniel Davies who works as a financial consultant. You have the worst upper abdominal pain that you’ve ever experienced. It’s 10/10 and excruciatingly painful. It’s going straight through your upper abdomen to your back. You have noticed that leaning forwards helps with the pain slightly. This morning you’ve vomited three times with the pain. You have been unable to keep any paracetamol down.
Last night you were at a corporate drinks event and there was an open bar. You lost count of how many drinks you had and you can’t really remember what happened last night.
If asked, you have an extensive history with alcohol, most nights after work you’ll have about 5 pints and you go out every weekend. You’re not concerned about your drinking as drinking is vital to your job. You’ve tried to cut back in the past but you miss job opportunities. You’re young so you’re not too concerned about the drinking.
You have no chest pain / SOB
No change in bowel habits / no lower urinary tract symptoms
You have no recent travel / not eaten anything unusual
– Nothing of note
– No previous operations
– Occasionally take paracetamol for headaches
– No known drug allergies
– Alcohol history as above
– You smoke about 20 cigarettes per day for the past 20 years
– If asked you occasionally take ecstasy (MDMA)
– You live at home alone, in a ground floor flat
– Your dad was a big drinker