Download GI CSL

STATION 1.
YOU ARE ON GP ATTACHMENT.
YOU ARE ASKED TO TAKE A HISTORY
FROM NANCY MC GRATH A 48 YEAR
OLD WOMAN.
STATION 1
PATIENT SCENARIO
You are Nancy McGrath, a 48 yr old woman.
You have been having episodes of severe pain in the upper part of your tummy
for the past week.
The pain is more on the right than the left. There is no radiation. It’s not a sharp
or burning pain – more a very severe dull pain.
You have had it 4 times over the past week.
It started on a Sunday afternoon after your lunch.
It built up slowly to the worst pain you’ve ever had, including labour pains. You
couldn’t get comfortable with it, you felt sick and sweaty. You were going to call
the out of hours GP but it started to settle down and you decided it was bad
indigestion. The meal had been very fatty. In all the pain lasted 4 hours or so that
time.
Since then it has recurred 3 more times in the evenings after your dinner, the
same pattern on each occasion.
You have delayed coming to the doctor because you have become worried with
the way it keeps coming back and are afraid it might be something serious. You
feel guilty for not looking after your health better, you know you are overweight
and eat an unhealthy high fat diet.
You feel well in between episodes, appetite normal, no weight loss or other GI
symptoms.
You have no urinary symptoms.
You are on the combined oral contraceptive pill and have been for years.
You are a non smoker, non drinker.
You are married with three teenage children, all well at home.
You have no significant past medical history.
Your parents are both still alive and in good health. You have no siblings.
EXAMINER SHEET STATION 1
STUDENT NAME____________
Inadequate Adequate
Good
Introduces self – first and second names and role
(medical student).
Checks identity of patient
Gains consent to take history
Establishes reason for presentation
Elicits patient’s ideas, concerns and expectations.
Establishes duration and pattern of symptoms
Asks about pain – location, type, radiation and
severity
Asks about relieving and exacerbating factors
including effect of food
Asks about associated symptoms
Asks about fever/ malaise
Asks about appetite, nausea, heartburn, dyspepsia,
vomiting, haematemesis, diarrhoea, steatorrhoea,
constipation, blood pr.
Asks about urological symptoms, dysuria,
frequency, haematuria
Asks about respiratory symptoms
Asks about medications
Asks about past medical history
Takes full social history
Conducts full systems review.
Checks history back to patient
Addresses patient concerns
Demonstrates empathy
What is most likely to be causing this patient’s symptoms?
BILIARY COLIC
Please give a global rating of this student: FAIL
BORDERLINE
Comment on strengths:
Comment on weaknesses:
PASS
STATION 2
YOU ARE IN A+E ON ATTACHMENT AND
ARE ASKED TO EXAMINE THE ABDOMEN
OF A 22 YEAR OLD MAN WITH
ABDOMINAL PAIN FOR THE PAST 24HRS.
STATION 2
PATIENT SCENARIO
THE STUDENT WILL EXAMINE YOUR TUMMY.
YOU ARE SORE ON THE LOWER RIGHT SIDE . IF THE STUDENT ASKS
TELL THEM THAT IS WHERE IT HURTS AND WHEN THEY TOUCH YOU
THERE SAY IT HURTS.
THE DEEPER THEY PRESS THE MORE IT HURTS.
EXAMINER SHEET STATION 3
STUDENT NAME____________
Inadequate Adequate
Good
Introduces self – first and second names and role
(medical student).
Checks identity of patient
Uses hand gel
Gains consent to examine patient
General Inspection – comments hydration, distress,
jaundice, anaemia.
Inspects hands – comments on palmar creases,
clubbing.
Asks patient to indicate where pain is
Inspects abdomen – scratch marks, scars,
distension, visible peristalsis.
Superficial palpation – starts as far from painful
area as possible
Palpates observing pts face for signs of distress
Deep palpation – all 9 divisions of the abdomen
Checks for rebound/ peritoneal irritation
Palpates for hepatomegaly
Palpates for splenomegaly
Percusses for liver and spleen, starting in the RIF.
Ballots the kidneys
Auscultates for bowel sounds
Offers to examine hernial orifices
Suggests DRE necessary
Summarises examination findings including
comments on guarding, rebound etc.
Ask the student to summarize their examination findings.
Please give a global rating of this student: FAIL
BORDERLINE
Comment on strengths:
Comment on weaknesses:
PASS
STATION 3
YOU ARE ASKED TO TAKE A HISTORY
FROM MICHAEL MURPHY A 58 YEAR OLD
MAN
ADMITTED
FOR
THE
INVESTIGATION OF JAUNDICE.
STATION 3
PATIENT SCENARIO
You are Michael Murphy, a 58 year old man.
You presented to your GP 3 days ago because your wife noticed that you seemed
to be changing colour and becoming jaundiced.
Up to about a month ago you were feeling well, then you began to feel
progressively more tired and lost your appetite a bit. You have lost about half a
stone in weight over the same period. At the time you attributed that to work
related stress, you are a salesman and are under a lot of pressure to keep your
sales up , some of your colleagues have been let go and you don’t feel secure in
your job.
You have no nausea or abdominal pain but have now lost interest in food
completely. You are a bit constipated as you are not eating much. You have not
had any temperature.
You have noticed since you came into hospital that your urine is darker than
normal and your stools paler.
You travelled to Egypt 6 weeks ago for a sales conference but had no illness there
and stayed in a 5 star hotel in a resort. You had the vaccinations recommended
before you went – you think there was one for hepatitis. You have never had a
blood transfusion.
You are a married man with three adult children.
You will not appreciate being asked about your sexual history unless the
reasoning is properly explained to you, likewise any questions about drug
abuse.
You have no other symptoms but are very concerned about the fact that you are
missing work through this illness. You just want to get sorted and get out of
hospital as soon as possible.
EXAMINER SHEET STATION 3
STUDENT NAME____________
Inadequate Adequate
Good
Introduces self – first and second names and role
(medical student).
Checks identity of patient
Gains consent to take history
Establishes reason for presentation
Elicits patient’s ideas, concerns and expectations.
Establishes duration of symptoms
Asks about symptoms preceding the jaundice
Asks about abdominal pain
Asks about appetite, nausea, weight loss, pruritis
Asks about fever and malaise
Asks about changes in stool and urine colour
Asks about heartburn, dyspepsia, vomiting,
haematemesis, diarrhoea, steatorrhoea,
constipation, blood pr.
Asks about foreign travel and vaccinations
Asks about blood transfusions, tattoos and iv drug
abuse.
Asks about alcohol intake
Asks about medications
Asks about past medical history
Takes full social history
Raises the issue of sexual history without offending
pt.
Conducts full systems review.
Checks history back to patient
Addresses patient concerns
Demonstrates empathy
What is most likely to be causing this patient’s symptoms? CA. PANCREAS
Please give a global rating of this student: FAIL
BORDERLINE
Comment on strengths:
Comment on weaknesses:
PASS
STATION 4
MR SEAN O’CONNOR IS A 67 YEAR OLD
MAN WITH UNEXPLAINED WEIGHT LOSS
OF APPROX 1 STONE OVER THE PAST 2
MONTHS.
HE IS IN HOSPITAL FOR INVESTIGATIONS
AT PRESENT.
YOU ARE ASKED TO EXAMINE HIM FOR A
POSSIBLE GI CAUSE.
EXAMINER SHEET STATION 4
STUDENT NAME____________
Inadequate Adequate
Good
Introduces self – first and second names and role
(medical student).
Checks identity of patient
Uses hand gel
Gains consent to examine patient
General Inspection – comments on weight loss,
hydration, distress, jaundice, anaemia.
Inspects hands – comments on palmar creases,
clubbing, checks for flap.
Inspects arms for scratch marks, petechiae, spider
naevi, rashes.
Inspects face- anaemia, jaundice.
Examines mouth – angular stomatits, glossitis,
ulcers.
Palpates cervical lymph nodes.
Inspects abdomen – visible masses, scratch marks,
scars, distension, visible peristalsis.
Superficial palpation – all 9 divisions.
Palpates observing pts face for signs of distress
Deep palpation – all 9 divisions of the abdomen
Palpates for hepatomegaly
Palpates for splenomegaly
Percusses for liver and spleen, starting in the RIF.
Ballots the kidneys
Auscultates for bowel sounds
Offers to examine hernial orifices
Suggests DRE necessary
Summarises examination findings.
Ask the student to summarize their examination findings.
Please give a global rating of this student: FAIL
BORDERLINE
Comment on strengths:
Comment on weaknesses:
PASS
STATION 5
YOU ARE ON GP ATTACHMENT AND ARE
ASKED TO SEE MARY CARROLL A 55
YEAR OLD LADY IS BEING REFERRED
FOR A GASTROSCOPY FOR DYSPEPSIA
SYMPTOMS.
YOU ARE TO TELL HER THAT SHE HAS
BEEN REFERRED FOR THE TEST AND TO
EXPLAIN THE PROCEDURE TO HER.
STATION 5
PATIENT SCENARIO
You are Mary O’Carroll, a 55yr old lady who has come to see the GP with
indigestion going on for the past few months
. After your meals you are getting burning discomfort in the upper part of your
tummy. It settles a bit with Rennies or a glass of milk.
You were hoping the GP would just give you some tablets but he wants to send
you to hospital for another test and has sent you in to talk to the student about the
test.
You are getting worried that the GP thinks there’s something serious going on.
You feel perfectly well and have no symptoms apart from the indigestion
You are single and work in a post office.
You have no past medical history.
Both your parents are dead. They both lived into their 90s and died of old age.
You have a brother and sister. You brother had a heart attack a few years ago but
is fine now and your sister is also well.
You are fit and active and eat a balanced diet. You don’t smoke and you drink a
few glasses of wine at the weekend.
In relation to the test you want to know why you are being sent for it, will you
have to stay the night, will you be asleep for it, what are they looking for,
could it be something serious and how will you feel afterwards?
Will you get the results straightaway or will you have to wait?
EXAMINER SHEET STATION 5
STUDENT NAME_____________
Inadequate Adequate Good
Introduces self, first and second name and explains
role.
Checks patient identity
Gains consent for consultation
Ascertains patients understanding of need for further
investigation.
Explains reason for referral – need to identify cause of
symptoms, discusses possible findings.
Ascertains patient’s understanding of endoscopy
Explains procedure – day case, sedation, camera,
biopsy.
Advises pt about drowsiness after test and need to
arrange a lift home from hospital.
Outlines to patient how results will be communicated
to her .
Does not frighten the patient
Elicits patients concerns
Addresses patient concerns
Does not use medical jargon
Demonstrates empathy
Checks patient understanding - Asks patient to repeat
back explanation
Please give a global rating of this student: FAIL
BORDERLINE
Comment on strengths:
Comment on weaknesses:
.
PASS
STATION 6
EXAMINE THIS PATIENT
PRESENTED TO A+E.
WHO
HAS
HE IS COMPLAINING OF PROGRESSIVE
SWELLING OF HIS ABDOMEN AND DRINKS
60 UNITS OF ALCOHOL PER WEEK.
EXAMINER SHEET STATION 6
STUDENT NAME____________
Inadequate Adequate
Good
Introduces self – first and second names and role
(medical student).
Checks identity of patient
Uses hand gel
Gains consent to examine patient
General Inspection – comments on
alertness,weight, hydration, distress, jaundice,
anaemia.
Inspects hands – comments on palmar erythema,
clubbing and leuconychia, checks for flap.
Inspects arms for scratch marks, petechiae, spider
naevi.
Examines mouth – angular stomatits, glossitis,
ulcers, dentition. Fetor hepaticus
Inspects chest – comments on gynacomastia, spider
naevi, loss of body hair.
Inspects abdomen – visible masses, scratch marks,
scars, distension, caput medusa,.
Superficial palpation – all 9 divisions.
Palpates observing pts face for signs of distress
Deep palpation – all 9 divisions of the abdomen
Palpates for hepatomegaly
Palpates for splenomegaly
Percusses for liver and spleen, starting in the RIF.
Ballots the kidneys
Auscultates for bowel sounds
Checks fluid thrill
Checks for shifting dullness
Makes reference to exam of ext. genitalia.
Suggests DRE required
Summarises examination .
Ask the student to summarize their examination findings.
Please give a global rating of this student: FAIL
BORDERLINE
Comment on strengths:
Comment on weaknesses:
PASS