Location: You are a foundation doctor in the emergency department
Patient: 80 year old patient has presented with right sided blurry vision
– 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 an 80 year old patient. You developed a blurry right eye which came on today. When your carers arrived they were worried about you, so they called an ambulance. You think this is all very silly and do not like causing a fuss.
You do usually have glasses but your vision but your vision isn’t usually this bad. You have had no floaters or flashes or light.
If prompted you have had a right sided headache over the past week. You do get headaches from time to time but this felt different. The pain was most present in the right temple and radiates to the jaw. You noticed the pain was there when you were brushing your hair this morning. Yesterday you had some co-codamol but this did not help with the pain.
Over the past couple of days your jaw has been hurting when you have been eating.
You also have associated pain and stiffness in your beck and shoulders.
You have fatigue and you have noticed your clothes have been more lose recently.
PMH – High blood pressure – High cholesterol
DH – Amlodipine – Simvastatin – No known drug allergies
SH – Ex-smoker. Smoked when you were 16 years old, 15 a day for about 10 years – You do not drink alcohol – You live at home with carers four times a day
ICEF – You are worried that your vision is not improving. You want to know when your sight will come back
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.