• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a Foundation Doctor in General Practice

Patient: 50 year old male patient has come to discuss chest pain they have been experiencing

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 50 year old male patient.

Over the past 3 months you have been experiencing with some chest pain that comes and goes. You work as a builder, so at first you thought that you had pulled a muscle but the pain is sometimes there even when you aren’t at work. You have come to the doctors as the pain hasn’t gone away after several months and seems to be getting worse!

The pain is over the center of your chest. You have noticed the pain comes on when moving some bricks and walking materials upstairs. You have also noticed the pain when walking upstairs at home. The pain is a dull ache in the centre of your chest. The pain does not go anywhere else or radiate through to your back or shoulder. The pain lasts for about 5 mins and goes away when you sit down. You have not experienced this pain when you are sitting down.

You have no nausea or vomiting, loss of consciousness, dizziness, palpitations. You do not experience any shortness of breath when laying flat or at night. You have no swelling in your legs.

Past Medical History
– You have not seen a doctor about anything
– You have not been diagnosed with: stroke, ischemic heart disease, peripheral vascular disease, diabetes, hypertension (high blood pressure)

Drug History
– You have no prescribed medications
– You have no known drug allergies

Social History
– You live at home with your partner
– You smoke 5 per day but you are trying to stop
– You drink 8 pints of beer on a Friday and Saturday
You work as a builder, you are self employed and own the business

Family history
– Your father died of heart problems but you don’t know any more details than this

Ideas, concerns, expectations and feelings
You are worried you have a heart problems but you are hoping the doctor will say this is muscular. Because you run a business, you are worried that you have to take some time off work.

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.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are talking to
Asks patient for preferred name


PC 1 Presenting complaint 1
Site
Onset
Character


PC 2 Presenting complaint 2
Radiation
Exacerbating
Relieving factors
Severity


Associated features 1
Dyspnoea (shortness of breath)
Nausea
Sweating
Cough


Associated features 2
Palpitations
Syncope / dizziness
Oedema


Systems review Systems review
General = fever, rigors, night sweats, weight loss
Gastrointestinal = dysphagia, N&V, indigestion / reflux, abdominal pain, change in bowel habit


PMH Past Medical History
Past medical history appropriately explored
Specifically asks for 3 of: hypertension, myocardial infarction, hyperlipidaemia, diabetes, lung disease


DH Drug History
Drug history appropriately explored
Drug allergies


SH Social History
Alcohol
Smoking
Job
Living situation


FH Family history
Family history appropriately explored


ICEF ICEF
Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions


Question Given your history what are your differentials?
Angina
Ischemic heart disease
Myocardial infarction
Musculoskeletal chest pain
Dyspepsia / reflux
Biliary colic
Peptic ulcer
COPD
Pneumonia



Score