Location: You are a junior doctor in general practice
Patient: Tim is a 10 year old boy with an itchy rash, who is accompanied by his parent
Task: – Take a focused history from Tims parent – After 5 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 Tims mum. Tim is a 10 year old boy.
You have brought him into clinic as he has developed an itchy rash over the last 4-6 weeks and you want someone to take a look at it.
If asked further, the rash started on the elbows but has been getting bigger and worse over the weekends, now it is mainly on his arms and face. His skin is very dry and rough. Over the last week he has been constantly scratching and sometimes there has been bleeding because of this. He is struggling to sleep and is waking up more than usual. This is starting to also impact on both you and your partner.
You have noticed that this is worse in hay fever season and when he is around pets (as you do not have these at home).
If asked you have never noticed any lip swelling or breathing issues. You have not noticed the rash to be worse with any particular foods.
Tim has not come into contact with any other unwell children. Tim has not recently been on holiday.
You are worried because this has been going on so long you went online and have read that itchy skin can be highly contagious. You are worried about going to play dates, swimming lessons and other play groups you attend.
Past Medical History (PMH) Usually fit and well
Drug History (DH) No regular medications No known drug allergies
Family History (FH) You have asthma
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.