Location: You are a Foundation Doctor in General Practice
Patient: 45 year old patient has attended with a painful left shoulder
Task: – Take a focused history from the patient – After 4 minutes you will perform a focused examination – After your examination you will be asked a series of questions by the examiner
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.
This station includes both history and examination listed below
History You are a 45 year old women who has presented with worsening left shoulder pain that has been getting gradually worse over the past 2 months. You do not recall any falls or traumatic events to your shoulder. You do not experience any neck, arm, hand pain or alternated sensation. The pain is worst when you move your arm, particularly when you try to move your hands above your head. You are unable to sleep on the left hand side as this brings on the pain.
If asked you are struggling to get dressed by yourself, in particular putting on and off tops. You are also finding it difficult to blow dry and brush your hair.
Past medical history – Hypothyroidism – Type 1 diabetic
Drug history – Thyroxine – Novorapid insulin – Lantus insulin – No known drug allergies
Social history – You used to smoke when you were younger but you haven’t smoked for 15 years. You used to smoke about 5 per day.
Examination – You have decreased range of both active and passive range of motion of the left shoulder – You have forward flection to 60 degrees, abduction to 60 degrees and external rotation to 10 degrees – Pain is worse at the end of movements – Rotator cuff strength is normal
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.