Gastrointestinal System
CANDIDATE INSTRUCTIONS
You are a resident year 1 doctor working in the acute assessment unit. A 37-year-old man has presented and is complaining of recurrent upper abdominal pain.
Please take a complete history
At 8 minutes, the examiner may ask you some further questions.
2 Minutes Reading Time
10 Minutes Station Time
Total 12 Minutes
EXAMINER INSTRUCTIONS
Timing Instructions: At 8 minutes, stop the candidate and ask the following questions:
Question 1: What is your top 3 differential diagnosis?
Answer 1: Peptic ulcer disease (PUD), Gastritis, Gastro-oesophageal reflux disease (GORD)
Question 2: What is a common causative organism of PUD?
Answer 2: Helicobacter pylori
Question 3: What is the difference between duodenal and gastric ulcer?
Answer 3: In duodenal ulcer, pain usually improves after meals; while in gastric ulcer, it generally intensities after meals or have no symptoms at all.
-
Peptic Ulcer Disease (PUD)
PATIENT INSTRUCTIONS
-
Name: Adam McCue
Date of birth: 19/06/1887
-
“I have been having for some time now and it just keeps coming back!.”
-
Site- Hurts just right beneath my chest around the midline (points towards the centre in the upper abdomen)
Onset- Initially presented 3 weeks ago, now the pain has become worse and occurs three or four times per week.
Constant/intermittent- I don’t have the pain all the time. It comes and goes.
Character- Burning in nature
Radiating- No
Associated symptoms- Sometimes I feel nauseated when I am in pain. Yesterday I vomited for the first time. If directly asked, it was a sour, yellowish fluid. Thankfully, no blood.
Exacerbating- Pain is worse on empty stomach, and it often wakes me up at night.
Relieving factors- The pain is usually relieved within minutes by food, but then recurs within 2 to 3 hours. I’ve also tried antacids and it helps.
Severity- 6 out of 10 when the pain occurs.
Previous experience- This pain occurs occasionally for more than 2 years now
Red flag symptoms- No weight loss, loss of appetite, haematemesis, melaena, or tiredness
-
No change in bowel habits.
No urinary symptoms.
No chest pain or shortness of breath.
-
Ideas- “I don’t know what is going on, maybe it might be due to eating meals irregularly?”
Concerns- “My father had pancreatic cancer. Could I have it too?”
Expectations- “Please could you find out what’s the cause of this pain”
-
No history of previous/current medical conditions
No regular medications, apart from over the counter antacids.
No allergies
-
Father passed away due to pancreatic cancer at age 60.
No other family history.
-
Occupation- I am an executive for a new company, which has been quite stressful recently.
Diet- I have been drinking more caffeine and eating a lot of take-out foods due to long working hours
Alcohol- I only drink socially
Smoking- I’ve never smoked
Recreational drug use- None.
MARK SCHEME
Introduction
Ideas, Expectations & Concerns
Presenting Complaint
History of Presenting Complaint
Systems Review & Other Information
Past Medical History
Family History
Social History
Questions
Patient Scores
Enter Your Score Here: /42
SCORE GUIDE
High Pass: > 32
Pass: > 21
Borderline Pass: 15 – 20
Fail: < 14
Help us make this site even better—got ideas, requests, or just want to shake things up? Let us know with a quick click below!