Location: You are an foundation doctor in A&E
Patient: 60 year old patient presents to A&E with severe lower abdominal pain
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’re a 60 year old patient.
Over the last week you’ve been having worsening abdominal pain. Last night it was so bad you took your partner’s co-codamol they take for their back pain. This helped a little but you’re still unable to sleep with pain. In the morning your partner called 111 and you were brought to hospital by ambulance.
Over the past week your stools have been looser and you’ve been going about 3 times a day. You’ve not experienced any rectal bleeding or mucus discharge.
You have no urinary symptoms: dysuria, haematuria or frequency.
You’re nauseated but not vomiting.
PMH – High blood pressure (hypertension) – Type 2 diabetes mellitus – High cholesterol – Depression
SH – You live at home with your partner – You are a non-smoker – You have one glass of alcohol on the weekends
FH – You are adopted and you do not know your family history
DH – you are unsure of the doses – Metformin – Atorvastatin – Ramipril – You have been using your partners co-codamol – You have no known drug allergies
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.