Location: You are a Foundation Doctor on the Acute Medical Team
Patient: 72 year old patient was brought into hospital by ambulance with red flag sepsis. Patient had fallen at home and was short of breath when the ambulance arrived.
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 72 year old man who was admitted with a fall and shortness of breath. You bent down this evening and fell forwards feeling dizzy and hit your forehead, you managed to break your fall with out-stretched hands. You have not experienced any chest pain or palpitations. You think this is because you have not been drinking as much water as usual as you are less hungry than usual.
You have been short of breath for the last two weeks, you went to your GP with shortness of breath and they started you on antibiotics. Although this does not seem to of helped you.
Past medical history
Lung cancer – not for active treatment, this has been slow growing and your consultant does not think you would do well with treatment, so this is being monitored
Type 1 diabetic
Triple heart bypass
x4 fem/pop leg bypass
Drug history Lantus insulin
No known drug allergies
Social history You live at home with your partner You do not drink or smoke
Family history You have no conditions that run in your 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.