Location: You are a foundation doctor on the acute surgical take
Patient: 22 year old female, presented to A&E with left lower back pain
– 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 22 year old who has a three day history of back pain that has not been getting any better. You are struggling to sit still due to the pain. It is extremely painful, you have never had anything like this before. Pain score of 10/10. You have noticed the pain comes in waves moving from your left flank region to groin. You have experienced nausea but no vomiting.
You last opened your bowels today and there has been no change in your bowel habit. You are passing a good volume of urine but it has been a little more painful than usual.
You are getting worried as the pain is getting worse, you think this could be something more serious like cancer.
PMH = anxiety
DH = citalopram 20mg OD, no known drug allergies
SH = you work as a pub manager. You smoke 5 cigarettes per day. You drink socially, 2 pints twice a week
ICE = your friend had something like this and they had to have their appendix out. You want to know If you will need an operation or not.
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.