• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

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.

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


PC Headache
Site / position
Radiation
Visual symptoms


Pre-eclampsia symptoms
Vomiting
Abdominal pain
Oedema


AF Associated features 1
Vaginal bleeding & volume present
Fetal movements
Fever / rigors
Seizures


AF Associated features 2
Lower urinary tract symptoms
Change in bowel habit
Shortness of breath / chest pain


Current obstetric history 1
Anomaly scan done and result
Pregnancy complications to date
Admissions to hospital during pregnancy


Current obstetric history 2
Fetal movements
Contractions


Previous obstetric history 1
Previous bleeding during pregnancy (APH / PPH)
Previous obstetric issues (pre-eclampsia, gestational diabetes)


Previous obstetric history 2
Gravida (number of previous pregnancies)
Para (number of children born)


Previous obstetric history 3
Miscarriages (stage, complications)
Terminations (stage, method)


For each child born establishes:
Delivery at what week
Birth weight
Mode of delivery
Any abnormalities


PMH Past Medical History
Past medical history appropriately explored
Specifically asks about hypertension / pre-eclampsia


DH Drug History
Drug history appropriately explored
Drug allergies


SH Social History
Alcohol
Smoking
Job
Living situation


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


Question Given your history what are your differentials?
Pre-eclampsia
Other appropriate answer: migraine, tension headache, cluster headache ect.


Question What investigations would you like to do?
Blood pressure
Urine dip
Bloods = LFTs, Platelets, Clotting, U&Es (2 of these)
Cardiotocography (CTG)


Question
Please review the following investigations given to you by the nursing team. What is your most likely diagnosis based on these investigations?

Pre-eclampsia


Question What antihypertensive is used during pregnancy?
Labetolol



Score