Instructions to candidate: (These are posted outside the

station. You have one minute to read them. The instructions are also inside the station in case you need to refer to them again)

This is Jack Lion. He has just arrived in the Accident and Emergency Department. He is complaining o severe pain in the !ack.

"lease take a !rie

ocussed history.

The e#aminer $ill then give you the results o the physical e#amination.

%ith the in ormation you have o!tained

rom the

history and the reported physical e#amination& please e#plain the most likely diagnosis to the patient.

E#plain

to

him

the

urther

investigations

or

procedures he needs.

Here is the !ackground detail the simulated patient $ill have (please remember that you would not normally be able to see this)
Patients name Setting Timing 55 Jack Lion A+E department 8+1 minutes question sex age xx m 45-

%ho are you' You wor in a !ood pro"essing !a"tor# on a produ"tion $ine% &t is 'er# (ot in t(e !a"tor# and t(e# dont a$$ow #ou to ta e drin s in )e"ause o! t(e ris o! "ontaminating t(e !ood% You $i'e wit( #our spouse *no "(i$dren+% You (a'e ne'er smo ed You drin 1-, g$asses o! g$asses o! wine ea"( e'ening You do not exer"ise Your mood is norma$ *not anxious or depressed+ You are genera$$# quite eas# to ta$ to

"revious medical pro!lems Pre'ious$# !it and we$$ apart !rom mi$d ast(ma

(urrent health pro!lem You were we$$ unti$ t(e $ast 1, (ours You wo e in t(e ear$# (ours o! t(e morning wit( pain in #our )a" and side &ts on t(e rig(t side o! t(e )a" - .ust at t(e $ower end o! t(e ri)"age% &ts a se'ere pain and #ou "annot get into a "om!orta)$e position wit( it% You tried some para"etamo$ and t(en some i)upro!en in t(e nig(t- )ut neit(er (e$ped% Your partner was "on"erned a)out #ou and dro'e #ou (ere% If the candidate asks you: o T(e pain "omes and goes in wa'es o T(e pain is spreading round !rom t(e )a" down towards #our groin and it is "ausing #our testi"$es to a"(e%

o You do not (a'e an# pain or pins and need$es in #our $egs o You !ee$ 'er# si" )ut (a'ent a"tua$$# 'omited #et o You !ee$ sweat# o You noti"ed #our urine was 'er# dar and "on"entrated toda# / #ou t(in t(ats )e"ause #ou'e not )een drin ing enoug( o You (a'e )een doing a $ot o! o'ertime in t(e !a"tor# re"ent$# o You ate norma$$# unti$ $ast nig(t% You (a'ent eaten an#t(ing sin"e t(e pain started o Your )owe$s wor ed norma$$# #esterda#- )ut #ou (a'ent )een toda# )edical pro!lems in the amily Your mot(er (as de'e$oped a tou"( o! art(ritis in (er (ands and nees as s(es got o$der% Your !at(er died w(en #ou were #oung / #ou dont now t(e detai$s% &! as ed dire"t$#- #ou are aware t(at #our )rot(er (ad a idne# stone )edication Pres"ri)ed medi"ation / ni$ 0'er t(e "ounter medi"ation / ni$ A$ternati'e t(erapies - ni$ A$$ergies - ni$

*eelings and concerns You are rea$$# worried a)out t(is )a" pain% You t(in t(at it "ou$d )e a s$ipped dis" as #ou'e )een wor ing 'er# (ard re"ent$# You are (oping !or an x-ra# to put #our mind at ease% You a$so need a strong pain i$$er qui" $#

+uestions T(e examiner wi$$ inter'ene mid-wa# t(roug( t(e station to gi'e t(e "andidate t(e !indings o! t(e examination *t(e# wi$$ not )e examining #ou+%

0n"e t(e "andidate (as (ad time to a)sor) t(e in!ormation- as 1 2(at do #ou t(in t(e most $i e$# diagnosis is3 2(#3 2(at ot(er t(ings mig(t it )e3 4o #ou need to organise an# tests3 &! so- w(at wi$$ #ou wi$$ doing3

The e#aminer $ill give you the results o the physical e#amination in this case (sometimes you will be expected to perform the examination yourself)

E#amination *indings Temperature ,-.. degrees (entigrade "ulse //01min& regular 2lood pressure /-0130

He inds it di icult to lie still on his !ack. He has some tenderness in the right loin. All other e#amination indings are normal.