Gen Surg Examination 1
Station 1
My tummy won’t stop hurting!
Candidate Instructions
Setting:
You are a Foundation Year doctor working in the surgical assessment unit. This patient has presented with abdominal pain.
Name: Harriet Muir
Tasks:
1. Please examine the patient.
2. Present the exam findings AND a differential diagnosis to the examiner.
Simulated Patient Instructions
Briefing
Please act as the patient and reveal signs and results only as the candidate performs actions or requests tests.
Diagnosis: Biliary Colic.
You are Ms Harriet Muir aged 56.
You have presented to surgical assessment unit with abdominal pain.
Opening Statement
“I’ve come in because I’ve got this stomach pain that just isn’t going away. I’m worried it’s something serious.”
Appearance and Behaviour
You are communicative, but tired. You are in moderate-severe, spasmodic pain that comes in waves. You point to your stomach when they ask for the site of pain. On examination your pain is most severe over the right upper quadrant, making you wince when touched. Please follow all the physical prompts in the mark sceme to provide prompts to the candidate
Start the Timer and Begin
Intro
End of Bed Inspection
Examination space:
Patient:
Inspection
If the candidate requests obs at this stage state “the nurse is just preparing them for you”.
Palpation
Specific Organs
Percussion
Assessing for shifting dullness is a good habit to get into. In clinical practice it is often only done if initial dullness is palpated.
Auscultation
To Complete My Examination…
The candidate may consider PR or hernia examination although they are not necessarily indicated here so marks have not expressly been given. It is always worth mentioning them at the end of an Abdo exam as it will rarely be the wrong answer.
Examiner Instruction
At this point please direct the candidate to move on to present their findings to you.
Presenting the history
Please note - although the diagnosis is biliary colic give the mark for good clinical reasoning and not for the correct diagnosis.
A very good candidate may also go on to suggest brief initial investigations as part of their summary even if not expressly asked e.g. I would review with a senior, order initial bloods, and an US scan of the abdomen. This is a good habit to get into on the wards.
Submit for Scoring
Tags | Surgery | Examinations | Abdominal exam | Abdo exam | Biliary Colic | Gallstones
Station Written by: Dr Megan Burns
Peer Reviewed by: Dr Rishil Patel
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