Location: You are an FY1 on the acute medical team
Patient: 50 year old patient has presented with profuse diarrhoea
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 patient who has attended the hospital with diarrhoea. You were recently seen in hospital and told to re-attend if you weren’t feeling any better.
The diarrhoea started 3 days ago but has become more severe over the last 24 hours. There is a large volume of watery diarrhoea. You have been passing stools about 20 times a day. You are struggling to eat and drink. You have had no nausea or vomiting. You have no abdominal pain.
You have not recently eaten out. You have no recent travel abroad. You have not been in contact with anyone who is unwell.
You were recently seen by the medical team in hospital and treated for a chest infection. You were discharged home with some oral antibiotics and you completed the course 3 days ago. On the last day of taking the antibiotics you started to have this diarrhoea.
You have not noticed any mouth ulcers, back pain or painful red eyes.
PMH – usually fit and well. Recently admitted and treated for chest infection. No previous operations.
DH – no regular medications. Recently completed a course of oral co-amoxiclav. You have no drug allergies
SH – you do not smoke or drink alcohol. You live at home with your partner
– You are worried that the diarrhoea is not stopping. You are feeling very weak as you have not been able to eat or drink. You just want to feel better so you can get back to your normal life.
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.