acutely confused patient scenario
candidate brief
You are seeing Mary Edwards with her husband. She is an 85yo who was brought to ED with a change in behaviour. Please take a history from her husband.
70% history taking 20% clinical reasoning 10% communication
actor brief
You are Mr Edwards. You brought Mary, your wife, to ED today as she has been behaving differently for the last 2 days. She has been very sleepy in the day, and awake all night.
She has been quite chesty the last two days and not eating as much as she normally would.
PMH: hypertension, polymyalgia rheumatica on 2mg prednisolone daily, incontinence
DHx: amlodipine, prednisolone, adcal D3, folic acid, oxybutynin, topical oestrogen
NKDA
Social history: no carers, mobile with frame, still goes to her book club every week
examiner brief
- Introduce self
- Check identity of patient/relationship to patient
- Asks about specific symptoms
- Asks about specific red flags
- meningitis
- head injury
- stroke
- Systems review
- sensitively probes for safeguarding issues?
- Explains differentials
- Explains delirium
- rapid onset, fluctuating change in consciousness
- usually physical precipitant
- recovery after correct physical illness
- Suggests appropriate investigations
- Initiates appropriate treatment
- sick day rules for steroids
- empirical antibiotics?
- Invites questions and addresses concerns appropriately
- Global mark from examiner
- Global mark from patient/relative