STATION NUMBER: 1

HISTORY TAKING, CLINICAL REASONING, DATE INTERPRETATION & PATIENT

CONSULTATION

CANDIDATE INSTRUCTIONS

Patient
Consultation
20%

Data History Taking

Interpretation 47%
13%

Clincal
Reasoning
20%

You are a medical student on placement in the Emergency Department. A 67-

year-old male has presented with abdominal pain.
• History taking (14 marks): take a history of the presenting complaint
from the patient and summarise your findings at the end.
• Clinical reasoning (6 marks): please answer the examiner’s four
questions
• Data interpretation (4 marks): The examiner will present you with a
photo from the patient. Please describe your findings
• Patient consultation (6 marks): marks awarded for appropriate and
effective patient interaction
STATION NUMBER: 1
HISTORY TAKING, CLINICAL REASONING, DATE INTERPRETATION & PATIENT
CONSULTATION
EXAMINER INSTRUCTIONS 1
Station timings: all stations are thirteen minutes in duration (ten minutes for
undertaking the task, plus an additional three minutes to allow for feedback).
You must not move candidates on to additional tasks during the station; they
are responsible for managing their own time.
A whistle will be sounded during the station as follows:
• At the start: candidates have 60 seconds to read the candidate instructions
outside the room
• At one minute: candidates must enter the room and can commence their
station tasks
• At eight minutes: candidates have two minutes remaining to complete their
tasks.
• At ten minutes: candidates must end their tasks immediately. You have 3
minutes to provide feedback on their performance and suggest areas of
improvement if possible (help em’ out!)
• At thirteen minutes: candidates must leave the room and move onto their
next station. This is the same whistle as whistle 1, and candidates will have
60 seconds to read the candidate instructions outside the room
If a candidate finishes the station early, they must remain in the station until the
whistle is sounded at thirteen minutes.

Feedback: during the station before the feedback session, you must not provide
feedback to candidates at any time. If a candidate clearly misunderstands the
instructions, simply ask them to “please re-read the instructions.”
If, using your better judgement, you feel the candidate is struggling considerably
during the station, you may instead opt to use the time to teach the station how
to undertake the task being assessed, and pass on any advice you may have.

While examining candidates, only give a mark if the task is completed accurately
by shading the appropriate circle. If the task is not attempted, incomplete or
inadequately performed do not award the mark. Please fill in the mark sheet
contemporaneously as the candidate is performing the task. Grade the
candidate as fail, borderline, pass, or good pass.
STATION NUMBER: 1
HISTORY TAKING, CLINICAL REASONING, DATE INTERPRETATION & PATIENT
CONSULTATION
EXAMINER INSTRUCTIONS 2
Clinical Reasoning:
Once the candidate has completed the history, you should ask them the following four
questions:

Q1. Can you name three differential diagnoses and let me know which is your top
differential?
Q2. Give three investigations to explore your differentials further
Q3. What is Charcot’s triad?
Q4. If there is a stone obstructing the common bile duct, what definitive management
options are there?

Data Interpretation:
Once the candidate has answered your four questions, please present them with the
following photo (see large photo at the end of the mark scheme to provide to candidate).
Ask the candidate to describe their findings of this image. If the candidate is stuck, you
may prompt them with what imaging modality is in use, what is the anatomical location
of this investigation, what is the main pathological feature, and what is the likely
underlying diagnosis given the imaging results.
STATION NUMBER: 1
HISTORY TAKING, CLINICAL REASONING, DATE INTERPRETATION & PATIENT
CONSULTATION
ACTOR INSTRUCTIONS
KEY DETAILS:

• John/ Jane Williams

• 67 years old
• Location: Emergency Department
• Occupation: Supermarket Assistant
PRESENTING COMPLAINT:
You have bad tummy pains which have been going on for about a day. You have never
experienced anything like this before. You wanted to see if the pains would disappear
overnight but instead, they have worsened overnight and into this morning.
If asked directly – you have also noticed that your skin has turned slightly yellow

HISTORY OF PRESENTING COMPLAINT

ABDOMINAL PAIN – SOCRATES
SITE: RIGHT UPPER QUADRANT (It is in the upper right-hand side of your tummy, just below
your rib cage)
ONSET: It started suddenly after lunch yesterday
CHARACTERISTICS: There is a constant gnawing pain accompanied by intermittent sharp,
stabbing pains
RADIATION: The tummy pain spreads up around your right side. No radiation to the back.
ASSOCIATED SYMPTOMS: You have noticed that both the whites of your eyes and skin
seemed a bit yellow this morning.
TIMING: The pain has been constant since it started, and it is getting worse
ALLEVIATING FEATURES: Nothing has made the pain better. You have not tried eating so you
are unsure if this makes it better.
EXACERBATING FEATURES: Nothing has made it worse. You have not tried eating so you are
unsure if this makes it worse.
SEVERITY: 9/10. It is really bad.
SYSTEMIC REVIEW:

• FEVER: Since this morning you have been swinging between hot and cold. You have
also been shivering and shaking.
• No change to bowel habit
• Your urine appears very dark. It does not burn or sting to pass urine. You have not
needed to pass urine more than normal
• You have vomited twice today. You have brought up food stuff. No pus. No blood.
• No haematemesis
• No PR bleeding
• No recent weight changes
• No night sweats
• No fatigue
TRAVEL HISTORY:

• You have not travelled abroad recently

IDEAS, CONCERNS AND EXPECTATIONS:
IDEAS: You have no idea what is causing this
CONCERNS: You feel very unwell from the pain and also very scared as you have never
experienced anything like this before
EXPECTATIONS: You would really like some pain relief (bonus point if student offers pain
relief and anti-emetics to the patient) and you would also like to know what is going on
PAST MEDICAL HISTORY:

• You have struggled with sciatica in the past

• You had milder right upper tummy pains about 2 years ago but were told that this
was most likely due to gallstones, and you decided to not have a gallbladder removal
• Otherwise, you are fit and well
DRUG HISTORY:

• Occasional paracetamol and ibuprofen for the sciatica

• NKDA
SOCIAL HISTORY:

• Supermarket assistant – you work in Tesco stacking shelves, sorting out orders and
serving customers. It is a busy job, but you enjoy it. You have been unable to go to
work because of how unwell you feel
• You live with your wife/husband and are independent in all activities of daily living
• You smoke around 5 cigarettes a day and have done so for the last 40 years
• You will have a few pints at the weekend
• No recreational drug uses
FAMILY HISTORY:

• Your mother had diabetes. She passed away from a stroke aged 72
• Your father died of stomach cancer aged 56.
Answer questions directly. Answer all other questions in the negative (i.e. respond with no).
Do not volunteer additional information to non-direct questions.

Patient Assessment:
0 1
I did not feel confident, and the student did Student’s behaviour and manner were what I
not listen and respond appropriately to my would expect of a doctor and made me feel
views and concerns. confident and listened and responded to my
views and concerns.
STATION NUMBER: 1
HISTORY TAKING, CLINICAL REASONING, DATE INTERPRETATION & PATIENT
CONSULTATION

TASK DONE/CORRECT
Introduces self, identifies patient, explains purpose of interview, and O
obtains consent
Don/Doffs PPE OR “washes hands” O
History taking (enquires about):
Site of pain O1
Onset of pain O1
Character of pain O1
Radiation of pain O1
Associated symptoms (any 2 of: diarrhoea, vomiting, PR bleeding, O1 O1
haematemesis)
Time course O1
Severity of the pain O1
Jaundice O1
Systemic features - weight loss, night sweats, fevers, rigors O1
Past medical history O1
Drug history and allergies (both for 1 mark) O1
Family history O1
Smoking and alcohol (both for 1 mark) O1
Clinical reasoning
Q1. Name three differential diagnoses and let me know which is your O1 O1
top differential? (Any of the following for 1 mark, ascending cholangitis
as top differential for 1 mark):
Ascending cholangitis, acute cholecystitis, hepatitis, acute pancreatitis
Mirizzi syndrome, any other reasonable differential
Q2. Give three investigations to explore your differentials further (any O1 O1
of the following for 1 mark, for a total of 2 marks)
Bloods including FBC, UEs, LFTs, coagulation studies, group and save,
VBG, amylase/ lipase
ECG
Urine dip
Imaging: ultrasound is first line followed by MRCP to further visualise
CT abdomen if the diagnosis is uncertain

Q3. What is Charcot’s Triad? (must state all three features for the mark) O1
must state all three features for the mark)
Fever, RUQ pain and jaundice
Q4. If there is a stone obstructing the common bile duct, what O1
definitive management options are there?
• ERCP
• Surgical intervention – laparoscopy, laparotomy
Either suggestion will gain the mark
Data interpretation
Checks the patient details and correctly identifies the image is MRCP O1
Correctly states the anatomical location as the Common Bile Duct and O1
the Gallbladder
Correctly identifies the presence of calculi in the Common Bile Duct and O1
a calculus in the Gallbladder
Correctly states the diagnosis as ascending cholangitis O1
(choledocholithiasis is also acceptable)
Patient Consultation:
Non-verbal skills: eye contact/body posture/appropriate physical O1
contact
Balance of questions: open/closed/reflective O1
Structure: appropriate structure to interview O1
Rapport/empathy/patient concern: appropriate responses to patient O1
statements
Language: clear/understandable/no jargon O1
Patient assessment: from actor O1

Overall Assessment of Performance:

Fail O Borderline O Pass O Good Pass O
STATION NUMBER: 1
HISTORY TAKING, CLINICAL REASONING, DATE INTERPRETATION & PATIENT
CONSULTATION

CHI: 0101561234
Name: Williams, John/ Jane