Infective endocarditis


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a foundation doctor on the acute medical take

Patient: 25 year old women, generally unwell for the last month with night seats

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 25 year old patient who has been sent in by your general practitioner. You are weak and miserable at the moment; at night you are sweating profusely. You have seen a GP 3 times and have been given antibiotics but this has not seemed to of helped and you are still having night sweats.

If asked, this has been going on for slightly over a month, you have never felt this unwell before, you feel extremely run down and have no energy at all at the moment. You are more short of breath compare to normal. You are not eating much at the moment as you have lost your appetite and have lost about 10kg in weight.

You have no pain on urination and frequency is the same, although your urine has been darker than usual.

If asked, you are an IV drug user, you are unable to stop. At the moment you are mainly injecting into your groin. You smoke cigarettes when you can. You drink around 10 cans of beer a day. You currently have no fixed abode.

DH – you take no regular medications. You have no allergies.

You are concerned that despite having antibiotics you are not getting better and nobody seems to know what is wrong with you.

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.

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.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school, year or grade
Clarifies who they are talking to
Asks patient for preferred name


PC Presenting complaint, fever:
Onset of fever
Duration of fever
Exacerbating and relieving factors
Presence of night sweats


Cause of fever
Recent infections
Recent travel
Contact with anyone unwell
IV drug use


IV drug use
Drug
Site of injection
Sharing of needles
Frequency of use


Associated symptoms
Fatigue
Weight loss
Shortness of breath
Rigors
Skin changes e.g rash or swellings
Joint pain / stiffness
Cough
Urinary symptoms
Change in bowel habit


PMH Past medical history
Immunisation history
Previous hospitalisation
Medical treatment or surgery abroad
Surgical history


DH Drug history
Recent antibiotics
Immunosuppresants
Chemotherapy
Allergies


SH Social history
Alcohol history
Smoking history
Accommodation


ICEF Ideas, concerns, expectations, feelings
Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions


Question Given your history what investigations would you like to do?
Routine bloods (minimum of 3) = FBC, U&E, CRP, ESR, LFTs
Blood cultures
VBG
Urinalysis
CXR (Chest X-Ray)
ECG
Echocardiogram


Question Given your history what are your differentials?
Infective endocarditis
Groin abscess
TB
Lymphoproliferative disorder
Other acceptable answer


Question What are the risk factors for infective endocarditis?
Heart valve replacement
Heart valve disease (degenerative, rheumatic)
Intravenous drug use
Invasive vascular procedures
Previous endocarditis


Question What is the criteria used to diagnose infective endocarditis?
Modified duke criteria



Score