Location: You are a foundation doctor on the acute medical team
Patient: 55 year old patient has presented with a cough
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 55 year old patient, you have been having a horrible cough for the last 2 weeks. At first you thought you had a cold but after a week it still wasn’t getting any better. You went to the walk in centre and they prescribed you some antibiotics but said they probably wouldn’t make a difference as this is viral. You are a bit annoyed as you feel they didn’t properly examine you. This week you have still had the cough and it’s not getting better. You have tried everything, cold and flu drinks, tickly cough medicine and humidifiers.
You are feeling really run down. You have no energy at all, you are struggling to leave the house. You don’t have much appetite. You have not been going to work either, which is a problem because you are self employed, so you aren’t making any money.
If asked you have bringing up a lot of green stuff. There is no blood in the sputum. You are not breathless at rest but are when you try to climb the stairs which does not happen usually.
PMH – You are usually fit and well
DH – You take Citalopram 20mg OM (for anxiety) – You are allergic to codeine (when you take this you vomit)
SH -You are a self employed accountant – You live with your partner – You used to smoke 5/day but you gave up 3 months ago – You drink socially
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.