Professional Documents
Culture Documents
Examinee instructions
Opening scenario
Vital signs
Temperature: 99.5°F (37.5°C)
Blood pressure: 116/70 mm Hg
Heart rate: 102/minute
Respirations: 20/minute
BMI: 30 kg/m 2
Examinee tasks
Patient encounter
Patient instructions
Focused history
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Chief complaint
Pain in my stomach.
Location
In the middle and upper right part.
Quality
Dull.
Onset
12 hours ago.
Precipitating events
It started pretty soon after dinner yesterday.
Progression/constant/intermittent
It has not really gone away since yesterday evening. I think it is actually getting worse.
Previous episodes
None like this. I have had some stomach pain after meals before, but it has always gotten
better after a couple of hours.
Radiation
It hurts really bad all the way around to my back. And I also have some pain in my right
shoulder.
Alleviating factors
I tried a warm water bottle, but that did not do anything. Sitting hunched over or lying on
my side seems to help a little.
Aggravating factors
Moving and lying down on my back.
Associated symptoms
I felt sick to my stomach after dinner and threw up three times last night. I also feel a
little warm, like I might have a little bit of a fever.
Blood in emesis
Not that I noticed. Sounds awful!
Recent travel
Our last family vacation was 4 months ago.
Where to?
We went camping in Yosemite.
Fatigue
Just the normal tiredness that comes from chasing after kids.
Rash/skin changes
No.
Yellow skin color
No.
Urinary problems
No.
Changes in urine color
No.
Bowel problems
No.
Blood in stool
No.
Appetite
Before this episode I was eating the same amount as usual.
Weight changes
Not that I have noticed.
Recent infections
No.
Allergies
No.
Medications
Sometimes I take antacids at night when I cannot sleep because of heartburn.
Frequency
A couple times a month, after a big dinner late at night. But when I take the antacids it
goes away and I can sleep.
Hospitalizations
Just for the birth of each of my 2 children.
Ill contacts
No.
Family history
My father died of a stroke when he was 65. My mother has gallstones.
Work
I am a financial consultant.
Home
I live with my husband and 2 children. It is chaotic sometimes, but we do well together.
Alcohol
1–2 glasses of wine with dinner most nights. I had a little more than that the past 2
days because we had guests.
Recreational drugs
Never.
Tobacco
Never.
Exercise
I just cannot find the time.
Diet
I cook what the kids like to eat best – mac 'n' cheese, spaghetti and meatballs – comfort
food like that.
Focused physical examination
Washed hands
Murphy sign
Positive
Skin examination
Communication and interpersonal skills
Patient interaction
Examinee showed interest in the patient as a person (i.e., appeared caring and showed
respect).
Examinee demonstrated the ability to support the patient's emotions (i.e., offered
words of support, asked for clarification).
Examinee used non-medical terms and provided reasons for planned steps in
management.
Examinee evaluated the patient's agreement with the next diagnostic steps.
Suggested response to challenge: “Ms. Billings, I understand that you may be sensitive about
your weight, and it is not my intention to lecture you. I can assure you that, as your physician, I
want you to be in the very best possible health, and it is my job to look for ways for the two of us
to get you there, together. Would you be interested in discussing some options for how we can
do that?”
Patient note
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in this form: access the patient note here
For reference, see our list of common abbreviations for the patient note, which is similar to the
list that will be posted at every station during your CS exam: access the abbreviation list here
Further discussion
Patient note
Differential diagnoses
Diagnostic studies