Location: You are a foundation doctor on the ambulatory assessment unit
Patient: 70 year old patient has been referred by their General Practitioner to hospital 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 patient who has been having worsening shortness of breath over the past 4 days. You have gone to see your GP this morning and they’ve sent you up to the hospital.
You are usually breathless but never this bad. If asked you have been brining up green sputum. Your doctor said if you ever have these symptoms then you need to take some tablets they prescribed and you have done this. If asked what the tablets are you say prednisolone and antibiotics. You have been taking the tablets for the past 3 days and you aren’t getting any better.
If asked you have COPD, you take nebulisers at home. You do not have any home oxygen. Your exercise tolerance is about 100 yards.
DH – Adcal – Alendronic acid 70mg one per week – Atorvastatin 20mg OD – Budesonide 400mcg – Co-codamol 30/500mg – Salbutamol 100mcg – Symbicort inhaler – Tiotropium
PMH – COPD – emphysema
SH – You live at home with your husband – You used to smoke 20 per day for 20 years but you stoped 10 years ago – You do not drink alcohol – You are a retired cleaner
FH – Nothing runs in the family that you are aware of
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.