Patient: 21 year old male has become suddenly short of breath
– 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.
Background: you are a tall thin male who plays a lot of sports
You are a 21 year old male who started to get left sided chest pain last night whilst playing rugby. At the time you thought you had pulled a muscle and you continued to finish the game but you were very short of breath. When you woke up this morning you were still short fo breath and the pain was still there, so you decided to come into hospital.
If asked the pain is worse when you breathe in, it is worse over the left hand side. You are in mild discomfort but you do not require any painkillers if asked.
Rest of systems review unremarkable.
PMH = NAD
DH = no regular medications, NKDA
If asked you are worried that you have had a heart attack, you have seen the posters at work about central chest pain at work. You asked the doctor “Do you think this could be a heart attack.” You push the candidate to provide you with a yes or no answer if you could be having a heart attack and you do not let this go.