Location: You are a junior doctor in accident and emergency
Patient: A 45 year old female patient has come in with a headache
– 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 45 year old women who has presented to A&E, with the worst headache ever. You were out shopping today with a friend who is currently parking their car.
You were at the supermarket and you had the worst headache you have ever experienced, you thought you had been hit over the head with a bat. The headache came on instantly. The pain is all over your head, it is a sharp / pressure type pain. There is no radiation anywhere else. You have taken your sumatriptan but this has not helped as it usually does. You are very nauseous and have vomited once.
You admit to the doctor that you do usually suffer with migraines but this one feels different to what you usually get – it is much more intense and usually you only get migraines on the right side of your head but this one is all over. Usually when you have migraines you see “funny lines in my vision” but this time that did not happen.
You are embarrassed about coming into hospital as your friend thinks this is probably a bad migraine and you want the doctor to tell you that you are acting silly so you can go home.
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.