Location: FY1 doctor on the Surgical Assessment Unit (SAU)
Patient: 25 year old female patient has an acute history of lower abdominal pain
Task: – Take a focused history from the patient – After 6 minuets 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 to 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 25 year old female. You were out for dinner last night and felt a bit sick, with some abdominal pain, went home and went to bed. Woke up at 2am and vomited. You had severe abdominal pain much worse over the right hand side. You vomited again and was unable to sleep. Waited until the morning and booked an appointment with your GP, they have sent you straight into hospital and you don’t know what is going on. You have lost your appetite, have not had anything to eat and drink since yesterday evening.
If asked your periods are regular, you have just had your period over the last couple of days. You are not sexually active and take the combined pill. You do not think you could be pregnant.
PMH = asthma
DH = salbutmaol when you need it. If asked you are allergic to clarithromycin (you have diarrhea when you have this)
SH = drink socially on the weekends, non-smoker
ICE = you are worried about the pain as it does not seem to be getting any better.
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.