Location: You are an F1 working on-call in medicine
Patient: 70 year old presented with shortness of breath
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 70 year old retired accounts manager. Over the past month you have noticed you are increasingly finding it more difficult to get around the house. You now become very breathless when walking between rooms. You used to be able to walk down the road to your friends house with little problem. Now you struggle to make it to your front door.
You are not breathless when you are resting, it is only on exertion. You have had problems with sleeping, you struggle to sleep laying flat and so have starting sleeping in your reclining chair in your living room. If asked you have woken up at night gasping for breath and this has worried you a lot.
If asked your ankles have been more “puffy” and swollen than usual over the past month.
You have no fever, cough, wheeze, chest pain. You have not noticed any weight loss.
Past Medical History (PMH) – High blood pressure – High cholesterol – Type 2 diabetes
Drug History (DH) – Simvastatin – Amlodipine – You have no allergies
Social History (SH) – You used to smoke 20 per day for 30 years, you gave up 10 years ago – You have a glass of champagne once a week at brunch with your friends – You live in a two storey house. You live alone, your partner left you 10 years ago. You have a good support network with lots of friends on the street and your daughter lives a 5 min drive away and sees you everyday
Family History (FH) – No conditions run in the family that you are aware of