Breathlessness scenario 2
candidate brief
You are seeing 23yo Jenny who has presented with breathlessness.
history taking / clinical reasoning
actor brief
Jenny Hawkins 12/3/2003
You are Jenny, a 23yo who is day 7 postpartum. Yesterday, you started developing some chest pain that you initially thought was MSK, but it has only gotten worse over the last 24h. You now feel breathless especially on walking. The pain is sharp, worse when breathing in. When standing this morning, you had a near-faint.
PMH: nil
DHx: nil
NKDA
You had a spontaneous vaginal delivery a week ago, delivering a healthy baby at 39 weeks. You were discharged home the same day. This is your first child.
You are most worried about getting home to your baby and wife. If anticoagulation is mentioned, you are most concerned about how it might affect your baby as you are breastfeeding.
examiner brief
Aim - recognise PE as most high-risk differential
spo2 92% on air → 99% on 15L, RR 18
HR 117, BP 115/85
GCS 15/15
ECG - sinus tachy
- Washes hands, introduces self
- Confirms patient identity
- Checks patient comfort before starting
- Asks pertinent history
- site/character/onset of pain
- Family history of unprovoked VTE
- Past medical history
- Drug history and allergies
- Social history
- Asks about VTE risk factors
- Asks about bleeding risk (wrt VTE treatment)
- Explains differentials
- Explains need to examine patient
- Appropriate management plan
- Appropriate investigations
- bloods
- ECG
- CXR, CTPA
- Invites questions
- Addresses patient concerns
- Global mark examiner
- Global mark patient