General Surgery Station 3
Station 3
Acute onset abdominal pain
Candidate Instructions
Setting:
You are a junior doctor working in A&E. This patient presents with abdominal pain.
Name: Paul Pruitt
Tasks:
1. Take a history from the patient.
2. Give your differential diagnosis to the examiner.
3. Explain your initial management to the patient.
Simulated Patient Instructions
Briefing
Diagnosis: Acute pancreatitis presenting as epigastric abdominal painYou are Paul Pruitt 04/06/1965 (Age: 56)
You have presented to the Emergency Department with abdominal pain
Appearance and Behaviour
You should appear in significant pain, trying not to move as it makes the pain worse.
Opening statement
“I don’t know what’s happened, I just got this really bad pain right in the middle of my stomach, please help me”
Information to Give Freely
I got this pain in the middle of my stomach this morning and it’s just gotten worse, I even started vomiting a few hours ago.
Presenting Complaint
Site - Epigastric abdominal painOnset - About 12 hours ago
Character – Sharp stabbing pain
Radiation – Into the middle of your back
Associated symptoms - Vomited bile x6 times over the last 2 hours (No blood). No change in bowel habits. Bowels last opened this morning, it was normal. No lower urinary tract symptoms. Mild abdominal fullness.
Timing – It has continuously gotten worse over the last day and at no point did it ease up.
Exacerbating/relieving factors - Initially it was better with leaning forward and worse when lying on your back. Now nothing is helping and you’re trying not to move as it makes the pain worse.
Severity – Started as a 6/10, now it’s a 10/10
Past Medical History
Previous similar episodes - You had some abdominal pain because of gallstones earlier this year, but this feels different. You have a follow up appointment to discuss having your gallbladder taken out in a couple of weeks.Other medical conditions - High cholesterol, obesity
Previous surgeries - Appendicectomy 40 years ago. No complications following this.
Drug History
Prescribed - SimvastatinOver the counter - Paracetamol today, nothing else regularly.
Allergies - None known
Family History
None relevant.
Social History
Smoking history - Never smokedAlcohol - 2 pints of beer over the weekend
Home - lives with wife, teenage son, and a dog in a 3 story house
Mobility - Independent
ADLs - Otherwise fit and well. You and your wife manage at home very well. You’ve recently started trying to exercise at home with online courses to get into better shape. You’re very happy at home.
Systems Review
General/red flags - No fevers, weight loss, or night sweatsNeuro - Nil
Resp / Cardio- Nil
GI - Vomiting is present (as above), NO bowel changes, NO haematemesis, NO malaena
GU - Nil
Ideas / Concerns / Expectation
Ideas - Is it the gallstones againConcerns - That you’ll need surgery
Expectations - Something to ease the pain would be brilliant.
Discussion / Questions
If not already addressed by the candidate, you may ask if you'll have to stay in hospital as you're very keen to go home again.
Start the Timer and Begin
Intro
Presenting complaint
Past Medical History
Drug History
Family History
Social History
Systems Reviews
Ideas, Concerns, Expectations
Examiner Instruction
At this point please direct the candidate to move on to the diagnosis, and explanation stage of the station.
Diagnosis & Interpretation
Management
Explains management to patient including:
An exception candidate may also acknowledge risk scores for pancreatitis (eg Glasgow-Imrie score, Ranson’s Criteria, or APAChe II) although these are rarely used in practice by FY1s so you would not be expected to know this in an OSCE.
Submit for Scoring
Tags | General Surgery | Abdominal Pain | Acute Abdomen | Surgery | Gallstones
Station Written by: Dr Claire Holland
Peer Reviewed by: Dr Megan Burns
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