Location: You are an foundation year doctor on the acute medical take
Patient: 30 year old gentleman, has presented with a productive cough, fevers and some weight loss. Your consultants working diagnosis is bilateral apical TB. You have been asked to take a brief sexual history and discuss with the patient about a HIV test.
– After 6 minutes you will be asked a series of questions by the examiner
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 30 year old male.
You are shocked that the doctor wants a HIV test, you have never had sex with a man, so you do not see why you would need to be tested.
You have never had a HIV test before but have been to a clinic were they took some swabs and urinated in a plastic cup.
If prompted, you have been in prison for 3 years and prior to that you used to inject drugs. For a period of about 5 years you were homeless. Because of your addiction to ‘the drugs’ your mind is all messed up so you are unable to recall all the details but you swear that you haven’t touched drugs since leaving prison. You now live with your partner (of the opposite sex.)
You were admitted to hospital last year with a bad case of pneumonia but apart from that you are otherwise well.
You have no; dysuria, urethral discharge or testicular pain
Your last sexual contact was 3 days ago with a female partner, have been in a monogamous relationship for 3 years. You had oral and vaginal sex. You do not use condoms but she is on the combined pill.
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.