s2 scenario examples
TRANSCRIPT
-
8/12/2019 S2 Scenario Examples
1/20
INFORMATION FOR THE CANDIDATE Scenario N EX1
MRCP(UK) PACES
Station 2: HISTORY TAKING
Patient details: Mrs Heba Kamel, a 54-year-old woman
Your role: The doctor in the general medical outpatient clinic
Presenting complaint: Progressively worsening dyspnoea
Please read the letter printed below. When the bell sounds, enter the room. You have 14minutes to take a history from the patient, 1 minute to collect your thoughts and 5 minutes for
discussion. You may make notes if you wish.
Referral text:
Dear Doctor,
This retired nurse has had progressively worsening dyspnoea for the past 18 months. She hasa history of recurrent urinary tract infections and is on long-term antibiotic therapy.
She smokes 20 cigarettes per day and has done so for the past 20 years. She has no pastrespiratory history.
She has hypertension and is known to have right bundle branch block on her ECG.Examination reveals definite bi-basal crackles on auscultation of the chest. Full blood count andurea and electrolytes are normal.
Please see and advise on her management.
Your sincerely,
Your taskis to interview the patient and, based on the history you obtain, construct adifferential diagnosis and plan for investigation. You should explain these to the patient and
answer any questions they may have.
DO NOT EXAMINE THE PATIENT
Any notes you make must be handed to the examiners at the end of the station
-
8/12/2019 S2 Scenario Examples
2/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX1
MRCP(UK) PACES
Station 2: HISTORY TAKING
Your role: Mrs Heba Kamel, a 54-year-old woman
Location: The general medical outpatient clinic
History of presenting symptoms
Information to be volunteered at the start of the consultationYou present with an 18 month history of progressively worsening breathlessness. Now you getbreathless on walking 100 yards on the flat or after doing housework such as vacuuming. Thebreathlessness does not get worse at night and you sleep with 1 pillow. You have no history ofchest pain, palpitations, cough or ankle swelling. Your sputum is normal and you have nevercoughed up blood.
Information to be given i f askedNot applicable.
Background information
Past medical and surgical historyYour past history includes high blood pressure, varicose vein surgery and recurrent urinary tractinfections. Apparently youve been told you have an abnormal heart tracing but you do not thinkyou have any heart problems.
Other complaintsYour only other symptoms of note are nocturnal leg cramps and occasional flushes. Yousometimes get constipated but this doesnt bother you.
Medication record
Current medicationsYour have been on bendroflumethiazide 2.5 mg daily and lisinopril 20 mg daily for yourhypertension for a few years. Your doctor prescribed an antibiotic for your urinary tract infections10 years ago and you take this religiously, the dose being 50 mg at night. You are dreadful atremembering names.
Allergies and adverse reactionsYou are allergic to elastoplasts.
-
8/12/2019 S2 Scenario Examples
3/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX1
Personal history
LifestyleYou smoke 20 cigarettes per day and have done so for the past 20 years. You dont like the tasteof alcohol.
Social and personal circumstancesYou are a retired nurse (you retired to act as a carer for your son). Your husband is a mechanicand suffers from diabetes. He also had TB as a child. You have two sons. The eldest has a
history of diabetes also but this is well controlled and he is at university. The younger son has ahistory of cerebral palsy and still lives at home. You have a dog.
Your eldest son keeps pigeons and you have been looking after them for the past few yearswhen he is away on holiday or away at weekends. This usually involves you feeding them andcleaning out their cages a few days each month, several months a year.
Travel historyYou have never been abroad.
Family historyYour mother died of breast cancer aged 72 and your father had angina and died of a stroke aged
77.
Patients concerns, expectations and wishesYour breathlessness now makes it more difficult to care for your younger son. This concernsyou.
You have some specific questions for the doctor at this consultation:
What could be causing my symptoms?
Could it be related to my smoking?
Will it get worse and interfere with my ability to care for my son?
-
8/12/2019 S2 Scenario Examples
4/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX1
DATE CYCLE
MRCP(UK) PACES
Station 2: HISTORY TAKING
Examiners should advise candidates when there are 2 minutes remaining (i.e. after 12 minutes). Ifthe candidate appears to have finished early remind them how long is left at the station andenquire if there is anything else they would like to ask, or whether they have finished. If they havefinished, please remain silent and allow the candidate that time for reflection. The surrogate shouldremain until the end of the 14-minute period.
A good candidate would be expected to take a history which includes a detailed social history andactivities of daily living; and to particularly focus on the questions raised in the referral letter. At theend of the consultation the candidate should have discussed solutions to the problems posed bythe case. A good candidate would also give the patient the opportunity to ask any further questionsbefore closure. It is not necessary for candidates to agree a summary with the patient during theirinterview.
Examiners are encouraged to make a rough record of the candidates consultation withthe patientas it progresses. This may highlight omissions in history taking, ambiguities that remainunresolved, and additional points that were not in the script.
The examiner is expected to ask the candidate whether they have formed a problem list orpreferred diagnosis and answer the questions in the Family Doctors letter. Following discussion ofthe answer to these questions the discussion should explore the issues raised.
Examiners should refer to the marking guidelines in the four skill domains on the mark sheet.
The box on the following page indicates areas of potential interest in this case. Both examinersshould consider these, and any other areas they feel appropriate, and agree the issues that acandidate should address to achieve a Satisfactory award for each skill. These should berecorded on the calibration sheet provided.
Examiners should also agree the criteria for an Unsatisfactory award for each skill.
Continued on next page
-
8/12/2019 S2 Scenario Examples
5/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX1
Problem: Progressively worsening dyspnoeaCandidates role: The doctor in the general medical outpatient clinic
Surrogates role: Mrs Heba Kamel, a 54-year-old woman
Examiners are reminded the boxes below indicate areas of potential interest, but are not intended asabsolute determiners of Satisfactory performance. It is for the examiners to agree and record thespecific criteria they will assess the candidate on during the calibration process.
Clinical skill Key issues
DifferentialDiagnosis (D): Probable diagnosis:
Nitrofurantoin induced pulmonary fibrosis.Plausible alternative diagnoses:
Extrinsic allergic alveolitis Chronic obstructive pulmonary disease
Chronic heart failureClinical
CommunicationSkills (C)
Obtain sufficient information from the history to draw up a list of
differential diagnoses Identify risk factors
Managing PatientsConcerns (F):
Addresses patients concerns
Clinical Judgement(Skill E):
Plan investigations including:
CXR
ECG
Pulmonary function tests
High resolution CT scan of chest
Immunological tests
Maintaining PatientWelfare (Skill G):
See mark sheet.
-
8/12/2019 S2 Scenario Examples
6/20
INFORMATION FOR THE CANDIDATE Scenario N EX2
MRCP(UK) PACES
Station 2: HISTORY TAKING
Patient details: Ms Donna Jones, a 47-year-old woman
Your role: The doctor in the general medical outpatient clinic
Presenting complaint: Fatigue
Please read the letter printed below. When the bell sounds, enter the room. You have 14minutes to take a history from the patient, 1 minute to collect your thoughts and 5 minutes for
discussion. You may make notes if you wish.
Referral text:
Dear Doctor,
I would be most grateful if you could see this woman who presents with increasing fatigue overthe last one year. I checked her full blood count and she has a haemoglobin of 7.8 g/dl with anMCV of 112 fl.
Please advise on her investigation and management.
Your sincerely,
Your taskis to interview the patient and, based on the history you obtain, construct adifferential diagnosis and plan for investigation. You should explain these to the patient andanswer any questions they may have.
DO NOT EXAMINE THE PATIENT
Any notes you make must be handed to the examiners at the end of the station
-
8/12/2019 S2 Scenario Examples
7/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX2
MRCP(UK) PACES
Station 2: HISTORY TAKING
Your role: Ms Donna Jones, a 47-year-old woman
Location: The general medical outpatient clinic
History of presenting symptoms
Information to be volunteered at the start of the consultationYou have been feeling increasingly tired particularly over the last year. As a consequence youhave stopped going out so much and rather than walking to the shops, half a mile away, you nowtend to take the car. There have been times when you have felt rather breathless on walking upeven relatively gentle inclines. You have had no headache, dizziness, nausea or vomiting. Thereis no history of abdominal pain or alteration in bowel habit. There is no history of change in yourweight or any mouth ulceration.
Information to be given i f askedNot applicable.
Background information
Past medical and surgical historyYou have never been particularly unwell before. In particular there is no history of any heart orchest problems. You were therefore very surprised when your Family Doctor told you that youhave anaemia (a low blood count).
Medication record
Current medications
You are not prescribed any medication but because of your fathers bowel tumour, a nurse friendhad suggested that taking a small dose of Aspirin might prevent the chances of developingsomething similar and you have been doing this over the last 5 years.
Personal history
LifestyleYou are a non-smoker. You take a moderate amount of alcohol (approximately 15 units perweek but mainly all at the weekend: equivalent to a bottle and a half of wine over the weekendperiod) and have never taken any more than that.
-
8/12/2019 S2 Scenario Examples
8/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX2
Social and personal circumstancesYou have a generally good diet although you tend towards being almost vegetarian. You do havea good intake of fruit and vegetables with little in the way of red meat.
Family historyIn your family history both your mother and grandmother had thyroid problems and you recall agreat aunt had to wear a wig because of premature hair loss. Your father had bowel cancer.
Patients concerns, expectations and wishesYou are anxious that your anaemia may be an indication of a more serious problem.
You have some specific questions for the doctor at this consultation:
What could be causing you to be anaemic?
If you could have a bowel cancer like your father as you remember he too was anaemic?
Could it be related to the Aspirin you have been taking yourself?
What tests will you need to have?
-
8/12/2019 S2 Scenario Examples
9/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX2
DATE CYCLE
MRCP(UK) PACES
Station 2: HISTORY TAKING
Examiners should advise candidates when there are 2 minutes remaining (i.e. after 12 minutes). Ifthe candidate appears to have finished early remind them how long is left at the station andenquire if there is anything else they would like to ask, or whether they have finished. If they havefinished, please remain silent and allow the candidate that time for reflection. The surrogate shouldremain until the end of the 14-minute period.
A good candidate would be expected to take a history which includes a detailed social history andactivities of daily living; and to particularly focus on the questions raised in the referral letter. At theend of the consultation the candidate should have discussed solutions to the problems posed bythe case. A good candidate would also give the patient the opportunity to ask any further questionsbefore closure. It is not necessary for candidates to agree a summary with the patient during theirinterview.
Examiners are encouraged to make a rough record of the candidates consultation with the patientas it progresses. This may highlight omissions in history taking, ambiguities that remainunresolved, and additional points that were not in the script.
The examiner is expected to ask the candidate whether they have formed a problem list orpreferred diagnosis and answer the questions in the Family Doctors letter. Following discussion ofthe answer to these questions the discussion should explore the issues raised.
Examiners should refer to the marking guidelines in the four skill domains on the mark sheet.
The box on the following page indicates areas of potential interest in this case. Both examinersshould consider these, and any other areas they feel appropriate, and agree the issues that acandidate should address to achieve a Satisfactory award for each skill. These should berecorded on the calibration sheet provided.
Examiners should also agree the criteria for an Unsatisfactory award for each skill.
Continued on next page
-
8/12/2019 S2 Scenario Examples
10/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX2
Problem: FatigueCandidates role: The doctor in the general medical outpatient clinic
Surrogates role: Ms Donna Jones, a 47-year-old woman
Examiners are reminded the boxes below indicate areas of potential interest, but are not intended asabsolute determiners of Satisfactory performance. It is for the examiners to agree and record thespecific criteria they will assess the candidate on during the calibration process.
Clinical skill Key issues
DifferentialDiagnosis (D): Probable diagnosis:
Pernicious anaemiaPlausible alternative diagnoses:
Gastrointestinal disease Alcohol excess
Dietary insufficiencyClinical
CommunicationSkills (C)
Obtains a history of symptomatic anaemia.
Identifies a significant family history of autoimmune disease.
Managing PatientsConcerns (F):
Addresses patients concerns
Clinical Judgement(Skill E):
Indicates a likely diagnosis and explain further investigations for this(antibody tests and possible Schilling test)
Indicates likely treatment options with parenteral B12 supplementation.
Maintaining PatientWelfare (Skill G):
See mark sheet.
-
8/12/2019 S2 Scenario Examples
11/20
INFORMATION FOR THE CANDIDATE Scenario N EX3
MRCP(UK) PACES
Station 2: HISTORY TAKING
Patient details: Miss Geraldine Pearson, a 25-year-old woman
Your role: The doctor in the general medical outpatient clinic
Presenting complaint: Hypoglycaemia
Please read the letter printed below. When the bell sounds, enter the room. You have 14minutes to take a history from the patient, 1 minute to collect your thoughts and 5 minutes for
discussion. You may make notes if you wish.
Referral text:
Dear Doctor,
I would be grateful if you would see this patient as she is having increasing problems withhypoglycaemia.
She has had type 1 diabetes for 19 years and generally has not been troubled by it. Over thelast 6 months she has had increasingly frequent and more severe episodes of hypoglycaemiaand she says she is now getting no warning symptoms. Her partner has had to force feed herjam at night to resuscitate her on a number of occasions. He is particularly concerned about theeffect on her work.
Her latest HbA1c was 8.5% (IFCC: 69 mmol/mol) which is an improvement from 9.8% (IFCC:84mmol/mol) last year.
Your sincerely,
Your taskis to interview the patient and, based on the history you obtain, construct a
differential diagnosis and plan for investigation. You should explain these to the patient andanswer any questions they may have.
DO NOT EXAMINE THE PATIENT
Any notes you make must be handed to the examiners at the end of the station
-
8/12/2019 S2 Scenario Examples
12/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX3
MRCP(UK) PACES
Station 2: HISTORY TAKING
Your role: Miss Geraldine Pearson, a 25-year-old woman
Location: The general medical outpatient clinic
History of presenting symptoms
Information to be volunteered at the start of the consultationYou have had type 1 diabetes since the age of 8. You have never taken particularly close care ofyour diabetes, but it has never caused you any obvious problems.
Over the last 6 months you have been experiencing frequent episodes of hypoglycaemia both atnight and during the day. Previously you got warning symptoms of feeling hungry and shaky andsweating, but these do not now occur and you find that you suddenly cannot function at work orat home when, you test your blood sugar it is 2-3 mmol/L. You have also been woken at night byyour partner trying to feed you because you are restless, incomprehensible and your sugar is low.On one occasion recently you lost consciousness after having got up to get some food. Yourpartner is concerned about you and what he can do to help you.
Information to be given i f askedNot applicable.
Background information
Past medical and surgical historyYou have been told that you have normal changes of diabetes in your eyes, but have never hadlaser treatment, and have eye examinations every year by the mobile screening service. Youhave also been told that you have some loss of sensation in your feet when they are tested and
you tend to get hard skin which can crack, but otherwise do not have problems with your feet.You have never been told that there are any kidney problems from diabetes, but you have notprovided a urine sample for testing for the last few years because you check your blood instead.Your blood pressure is said to be normal.
Other complaintsYou use a cartridge pen injector to give your Insulin. You always inject in your thighs becausethat is easiest. There is some lumpiness at your commonly used injection sites.
-
8/12/2019 S2 Scenario Examples
13/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX3
Medication record
Current medicationsYou take insulin 4 times daily, Human Actrapid 2428 units with meals and Human Insulatard 38units at bedtime.
You are on the standard oral contraceptive pill and have been for 4 years.
Personal history
LifestyleYou have started going to the gym to exercise regularly 4 evenings a week for the last 8 monthsto try and help you to lose weight. You also enjoy going to the cinema and eating out. You eatregularly but have been trying to miss extras to help lose weight.
Social and personal circumstancesYou have been living with your present partner for 8 months, and have been thinking aboutgetting married and starting a family.
Occupational historyYou have been in your present job for 6 years and are happy in it. Friends and colleagues at
work know you have diabetes but until recently it hasnt caused problems. Recent re-staffing hasmade it more difficult to get regular fixed breaks for meals and snacks, the timing of these willvary between days.
-
8/12/2019 S2 Scenario Examples
14/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX3
DATE CYCLE
MRCP(UK) PACES
Station 2: HISTORY TAKING
Examiners should advise candidates when there are 2 minutes remaining (i.e. after 12 minutes). Ifthe candidate appears to have finished early remind them how long is left at the station andenquire if there is anything else they would like to ask, or whether they have finished. If they havefinished, please remain silent and allow the candidate that time for reflection. The surrogate shouldremain until the end of the 14-minute period.
A good candidate would be expected to take a history which includes a detailed social history andactivities of daily living; and to particularly focus on the questions raised in the referral letter. At theend of the consultation the candidate should have discussed solutions to the problems posed bythe case. A good candidate would also give the patient the opportunity to ask any further questionsbefore closure. It is not necessary for candidates to agree a summary with the patient during theirinterview.
Examiners are encouraged to make a rough record of the candidates consultation with the patientas it progresses. This may highlight omissions in history taking, ambiguities that remainunresolved, and additional points that were not in the script.
The examiner is expected to ask the candidate whether they have formed a problem list orpreferred diagnosis and answer the questions in the Family Doctors letter. Following discussion ofthe answer to these questions the discussion should explore the issues raised.
Examiners should refer to the marking guidelines in the four skill domains on the mark sheet.
The box on the following page indicates areas of potential interest in this case. Both examinersshould consider these, and any other areas they feel appropriate, and agree the issues that acandidate should address to achieve a Satisfactory award for each skill. These should berecorded on the calibration sheet provided.
Examiners should also agree the criteria for an Unsatisfactory award for each skill.
Continued on next page
-
8/12/2019 S2 Scenario Examples
15/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX3
Problem: Hypoglycaemia
Candidates role: The doctor in the general medical outpatient clinicSurrogates role: Miss Geraldine Pearson, a 27-year-old woman
Examiners are reminded the boxes below indicate areas of potential interest, but are not intended asabsolute determiners of Satisfactory performance. It is for the examiners to agree and record thespecific criteria they will assess the candidate on during the calibration process.
Clinical skill Key issues
Differential
Diagnosis (D):Probable diagnosis:
Plausible alternative diagnoses:
ClinicalCommunicationSkills (C)
Gains a clear view of the current situation with the patientsdiabetes and itscomplications, and elucidates possible precipitation factors for theincreased hypoglycaemia and impaired hypoglycaemia awareness,including:
Meal patterns
Exercise patterns including sexual activity
Lipohypertrophy
Autonomic neuropathy Improving glycaemic control on soluble and isophane insulins.
Other endocrine causes e.g. Addisons disease, thyrotoxicosis, (renalfailure)
Managing PatientsConcerns (F):
Discusses the issue of the patients future marriage and potential plansfor pregnancy in the setting for poor glycaemic control.
Discusses education for the partner
Clinical Judgement
(Skill E):
Explains the need to vary injection sites, have an insulin regime tomatch a regular meal pattern, modify diet and insulin around exercise.
Explains the roles of other members of the diabetes team, and agrees acourse of action with the patient.
Understands the use of analogue insulins in type I diabetes. Explains the causes of changes in hypoglycaemia and hypoglycaemia
awareness. Elucidates the problems of night time hypoglycaemia. Understands and explains the evidence for good glycaemic control
preventing complications in type I diabetes; along with the importanceof glycaemic control in and around pregnancy in type I diabetes.
Maintaining Patient
Welfare (Skill G):
See mark sheet.
-
8/12/2019 S2 Scenario Examples
16/20
-
8/12/2019 S2 Scenario Examples
17/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX4
MRCP(UK) PACES
Station 2: HISTORY TAKING
Your role: Miss Lily Kwan, a 28-year-old woman
Location: The general medial outpatient clinic
History of presenting symptoms
Information to be volunteered at the start of the consultationYou have been feeling generally unwell for about three months. Over the last month you havedeveloped diarrhoea, which is loose but formed stool, with no blood or mucus. If asked the stooldoes not float in the pan and is not offensive smelling. You open your bowels approximately 5-6times a day and occasionally need to open your bowels once at night. You have no urinarysymptoms of any sort.
You have also noticed that youve lost weight unintentionally, having dropped from a size 12 to asize 10 in the last three months. You do not weigh yourself to be able to comment on exactweight loss.
Your appetite has not been affected and in fact you feel that if anything, you seem to be eatingmore than usual.
Information to be given i f askedYour periods have become erratic over the last 6 months with only occasional, scanty blood loss.You feel warm and sweaty a lot of the time and havent enjoyed the recent warm weather which isnot like you. Recently your hands feel somewhat shaky, and sometimes your writing has beendifficult to read. You have not noticed any problems with your eyes and have not developed anyskin rashes. You wonder if your neck has become a little swollen.
Background information
Past medical and surgical history
You have otherwise always been well. You have only been to hospital once before, for atermination of pregnancy at the age of 19. You do not take any prescribed medications, but havebeen taking vitamin supplements recently. You have no allergies.
Medication record
Current medications
None.
-
8/12/2019 S2 Scenario Examples
18/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE SURROGATE Scenario N EX4
Personal history
LifestyleYou smoke 5-10 cigarettes a day. If asked admit to occasionally smoking cannabis. You drinkabout two gin and tonics a day (a generous measure if asked).
Social and personal circumstancesYou live with your partner and have been trying to start a family recently.
Occupational historyYou work as an IT consultant.
Family historyBoth your parents died in their 80s. Your father had a heart attack, and your mother had coloncancer. There is no family history of inflammatory bowel disease or coeliac disease.
Patients concerns, expectations and wishesYou are concerned that you may have cancer as your mother had diarrhoea and lost weightbefore she was diagnosed with cancer. Also you have concerns about your fertility, which iscausing some friction between you and your partner.
-
8/12/2019 S2 Scenario Examples
19/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX4
DATE CYCLE
MRCP(UK) PACES
Station 2: HISTORY TAKING
Examiners should advise candidates when there are 2 minutes remaining (i.e. after 12 minutes). Ifthe candidate appears to have finished early remind them how long is left at the station andenquire if there is anything else they would like to ask, or whether they have finished. If they havefinished, please remain silent and allow the candidate that time for reflection. The surrogate shouldremain until the end of the 14-minute period.
A good candidate would be expected to take a history which includes a detailed social history andactivities of daily living; and to particularly focus on the questions raised in the referral letter. At theend of the consultation the candidate should have discussed solutions to the problems posed bythe case. A good candidate would also give the patient the opportunity to ask any further questionsbefore closure. It is not necessary for candidates to agree a summary with the patient during theirinterview.
Examiners are encouraged to make a rough record of the candidates consultation with the patientas it progresses. This may highlight omissions in history taking, ambiguities that remainunresolved, and additional points that were not in the script.
The examiner is expected to ask the candidate whether they have formed a problem list orpreferred diagnosis and answer the questions in the Family Doctors letter. Following discussion ofthe answer to these questions the discussion should explore the issues raised.
Examiners should refer to the marking guidelines in the four skill domains on the mark sheet.
The box on the following page indicates areas of potential interest in this case. Both examinersshould consider these, and any other areas they feel appropriate, and agree the issues that acandidate should address to achieve a Satisfactory award for each skill. These should berecorded on the calibration sheet provided.
Examiners should also agree the criteria for an Unsatisfactory award for each skill.
Continued on next page
-
8/12/2019 S2 Scenario Examples
20/20
NOT TO BE SEEN BY CANDIDATES
INFORMATION FOR THE EXAMINERS Scenario N EX4
Problem: Diarrhoea and weight lossCandidates role: The doctor in the general medical outpatient clinic.
Surrogates role: Miss Lily Kwan, a 28-year-old woman
Examiners are reminded that the boxes below indicate areas of potential interest, but are not intendedas absolute determiners of Satisfactory performance. It is for the examiners to agree and record thespecific criteria they will assess the candidate on during the calibration process.
Clinical skill Key issues
DifferentialDiagnosis (D): Probable diagnosis: Thyrotoxicosis
ClinicalCommunicationSkills (C)
Collects information regarding the nature of the diarrhoea, specificallyhistory consistent with fast transit and not with inflammatory change ormalabsorption.
Elucidates weight loss in the context of increased appetite and neckswelling.
Clarifies diagnosis, noting:
Tremor Heat intolerance
Oligomenorrhoea
Neck swelling
Eye problems
Skin rashes
Managing PatientsConcerns (F):
Explores and addresses the patients concerns
Clinical Judgement(Skill E):
Plans investigations that must include thyroid function tests.
Discusses likely initial management plan: block (carbimazole) andreplace (with thyroxine when euthyroid); beta blockers for temporarysymptomatic relief.
Maintaining PatientWelfare (Skill G):
See mark sheet.