Location: You are a foundation doctor working in obstetrics
Patient: 31 years old, 34 weeks pregnant presents with bleeding
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 31 year old female patient who is 34 weeks pregnant. This morning you were at work, you went to the toilet and you noticed some blood in the toilet bowl. If asked state about a large cup full. You put on a pad and it soaked straight through almost immediately, you were really worried about this so you called an ambulance and came into hospital.
You did not notice any pain at the time but have had a bit of mild cramping since being in hospital.
You have noticed the baby has been moving less over the past hour which is surprising because they have been really active in the last couple of weeks.
You have not experienced any nausea or vomiting, you have no fevers or rigors. You have no LUTS (lower urinary tract symptoms), you opened your bowels this morning without issues. You have not experienced any chest pain or shortness of breath.
Before this episode occurred you have not experienced any bleeding. Your 20 week scan was ‘normal’ although you are told your placenta was low down, you’re supposed to have a scan in two days time to see if its moved.
You have previously had one child, born at 37 weeks, birth weight 3kg, vaginal delivery, no problems during pregnancy. Now is 5 years old, healthy.
Past medical history – Frequent urinary tract infections as a child
Social history – You do not smoke – No alcohol or recreational drugs
When the candidate has finished answering your questions you should ask what they think is going on. If they decline – ask them to please tell you what they think is going on as you are really scared.
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.