Obstructive Jaundice


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an F1 doctor on the acute general surgical take

Patient: 35 year old women has presented to hospital with severe upper abdominal pain

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 35 year old who has had severe upper abdominal pain for the past 12 hours. It started after eating a Chinese last night with your family. The pain is under your ribs and travels through to your back, it is a 10/10. You have vomited multiple times and you feel very nauseous. You were given IV morphine in the ambulance and that helped with the pain. You have never had pain like this before.

If asked, you have pale stools and dark urine. Your bowels opened this morning, there has been no change in frequency or consistency of your stools. You have been shivering but you feel very hot. On the whole you feel very unwell. If directly asked, your partner has said you look a bit yellow recently and you are very concerned about this.

PMH

  • Type 2 diabetic
  • No previous operations

DH

  • Metformin 1g BD
  • No know drug allergies

SH

  • Lives at home with partner
  • Works as customer assistant at a supermarket
  • You have recently stopped smoking and now use a vape. You used to smoke 15 cigarettes a day for 20 years

FH

  • Nothing runs in the family

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are talking to
Asks patient for preferred name


HPC Abdominal Pain
Site
Onset
Character
Radiation
Timing
Exacerbation and relieving factors
Severity


Targeted questions
Jaundice
Pale stools
Dark urine


Intra abdominal malignancy screen
Weight loss
Change in bowel habit
Loss of appetite


Hepatitis screen
Intravenous drug user
Foreign travel
Blood transfusion
Sore throat
Tattoos
Enquires about autoimmune disorders


PMH Past Medical History
Type 2 diabetic
No previous operations


DH Drug History
Metformin 1g BD
No know drug allergies


SH Social History
Lives at home with partner
Occupation: customer assistant at a supermarket
Non-drinker
Past smoker


FH Family History
No significant family history


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


Question Given the history you have taken, what are your differentials?
Acute cholangitis
Choledocholithiasis
Pancreatitis
Hepatitis
Acute cholecystitis
Other appropriate answer


Question Given the history what blood tests would you like to order?
FBC
U&Es
LFTs
CRP
Amylase
Clotting
Hepatitis screen


Question If this patient had obstructive jaundice, what additional investigations would you request?
Abdominal USS
Magnetic resonance cholangiopancreatography (MRCP)



Score