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This 40 year old patient has presented to the emergency department with abdominal pain.

Please take a history.

You have 6 minutes and then will be asked some questions by the examiner.

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 40 year old female patient.

You came to A&E 1 week ago with similar pain. You were given some pain killers and you felt better so you were keen to go home.

This time the pain is much worse. The pain in worse in the upper region (you make a fist and rub it over the epigastric and RUQ region.) The pain is sharp and goes through to your back. You have been feeling nauseous and have been sick once.

For the last 6 months you have been having abdominal pain that comes in waves when you have a fatty meal, so you have cut these out of your diet.

Your last period (LMP) was 3 weeks ago

You have not been experiencing any lower urinary tract symptoms (increased frequency, burning or discharge)

Your bowels last opened this morning

You are not known to have gallstones although you have never had a scan

– Tonsillectomy

– You live at home alone
– You are a non-smoker
– You drink socially

– You are not on any regular medications
– You have no allergies

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.

Category Question
Introduction Candidate appropriately introduced themselves with:
Full name
Clarifies who they are talking to
Asks patient for preferred name

PC Presenting complaint
Timings of pain
Exacerbating and relieving factors

Associated features
Nausea and vomiting
Loose stools / change in bowel habit
Rigors / fevers / chills
Lower urinary tract symptoms
Not recently been unwell / not in contact with anyone unwell

PMH Past Medical History
Past medical history appropriately explored

DH Drug History
Drug history appropriately explored
Drug allergies

SH Social History
Living situation

FH Family history
Family history appropriately asked about

Explores ideas, concerns, expectations, feelings
Asks patient if they have any questions

Question Given your history what are your differentials?
Acute cholecystitis
Biliary colic
Ureteric colic

Question photo_camera Please review the following bloods and comment on your findings
Increased WCC
LFTs deranged
Increased CRP

Submit your answers to get your score.