Location: You are a foundation doctor working in obstetrics
Patient: 31 years old, 34 weeks pregnant presents with bleeding
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 31 year old female patient who is 34 weeks pregnant. Today you have developed a frontal headache and you have vomited twice today. You have some flashing lights and feel light headed. You have never had a headache like this during your pregnancy. When you get headaches you usually take ibuprofen but you didn’t want to take any medications without asking a doctor. You would like to know if you can take ibuprofen for the headache
If asked you have noticed your hands and feet have become more swollen.
If asked your mother had to deliver you earlier but you weren’t sure why that was
You do not have any: pv bleeding / lower urinary tract symptoms / fevers / chest pain / shortness of breath
Your 20 week scan was ‘normal’
This is your first pregnancy and you have never been pregnant before
Past medical history – Appendectomy
Drug history – You are not taking any regular medications – You have no drug allergies
Social history – You do not smoke – No alcohol or recreational drugs
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.