Location: You are an FY1 in A&E
Patient: 35 year old female patient who has presented to A&E feeling generally unwell with back pain and vomiting.
– 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 35 year old women who has been feeling really unwell for the past 3 days. If asked why you have come to hospital, explain that you have been vomiting this morning and have been generally unwell for the last 3 days, you have never experienced anything like this before. You have not been eating or drinking and have not been able to sleep because of the pain.
The pain is in your right lower back / right lower abdomen. It does not radiate anywhere else, it is constant in nature.
You have had horrible sweats. The sweating has been so bad that you have had to change your bed sheets 4 times in a day. Your partner has taken your temperature and said it was 40 degrees. You have been shivering / shaking intermittently.
You started vomiting this morning and you have no idea what caused this. You are vomiting any water or food that you have been trying to have.
If asked you have not passed any fluids in the past 2 days, you assume because you have not been able to drink anything.
In the past week you have been having experiencing pain when trying to urinate. You have not had any treatment for this.
You are sexually active with your partner, you have been together for the past 5 years. You had an STI check 3 weeks ago which was negative. You are not experiencing any discharge or abnormal PV bleeding. Your last period was 2 weeks ago and your cycles are regular.
No past medical history
No previous operations
No regular medications
No known drug allergies
You do not smoke but use a ‘vaper’ / e-cigarette
You drink 2 bottles of rose per week
You live with your parents
You work for a local charity in the social media department
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.