Ultimate Finals List - History Stations

History Stations

• Take a history of abdo pain...he had renal colic and told me when the bell went his urine was pink! You had to specifically ask if there was blood in the urine/changed colour- otherwise he said it was all normal. 
• ... next station was a follow on...u had to ring up the hospital and on the phone refer ur patient n the doc on the line asks u why u referring and what management plan do u propose...pt had a family history of gout so I said to screen for that, analgesia and further investigations cos he was male // Telephone referral of the case - not sure what they wanted. Finished way early. Looked like an idiot again as asked to speak to the med registrar, so the examiner hiding behind the screen said he was the surgical reg.. oh I said.. no, I want you!! :S // Talk to a Dr on a fake phone, I didn't check who I was talking to - so I gave all of the info to the man who picked up the phone, which could have been anyone- so check! // He then asked you for a differential and what tests you wanted to do. They provided you with urine analysis results and examination results, which confirmed renal stones - no signs of inf, but haematuria, plus tenderness in the loins 

• Cough hx, due to ACEi, so never omit the drug history. Was even asked about why ACEI give you cough and ATR blockers don’t. I discussed a chemical building up in body, normally broken down, some people mentioned bradykinin specifically. I’m not sure how much technical info a patient would want to hear // but u must say at the end that well change ur antihypertensive medication and see if cough improves n if it doesn’t well call u back in for more tests. cos they waned u to discuss a management plan with the pt in the quest // Smoking history with 40 pack year history, hence differentials are ACEi cough and maybe some underlying cancer of the lung. 

• History - diabetes history from knowledgeable patient, asked about complications. Had no differential diagnosis to make. 
• Hx Diabetes Mellitus in 19 yo girl with abdo pain and weight loss

• Splenectomy + pancreatectomy, HCV + HIV etc. 

• Hx - Rheumatoid Arthritis. You get 5 minutes before you start but no info. So just wrote down headings and surreptitiously studied the patient for clues! History taking was fine, but I missed the clue about TB in the family - he didn’t want to go on biologicals because of the risk of TB reactivation. Also re chronic conditions make sure you ask about previous medications patient have been on rather than just the current ones. Presented a differential diagnosis at the end. I also forgot smoking and alcohol till I heard my neighbour ask about it swiftly followed by the next door cubicle too! Questions on how to monitor RA (Esr/ Crp I think) How to diagnose, Dmards, how to protect vs possible Tb reactivation. Cjd from biologicals possibility? Should people with RA have joint replacements? Was straightforward I think. // rheum arthritis, also going through MJ THREADS was important as patients had TB in the past and lots of people didn’t pick that up. Asked to present the hx then asked about differentials, what the drugs were Anti TNF therapy what it was, Ix I would do...I mentioned anti ccp and the examiner seemed very impressed. // History for 20 mins from pt then 10 mins of qus from examiner. Lovely patient with rheum arthritis and kidney failure. Then she went out and I was asked about her meds etc and differentials for her kidney failure. I then asked examiner what the cause of it actually was- he didn't know! So I think as long as you gave a differential, it was fine. // Others histories that came up: stroke, scleroderma examiner asked me about RA so known ur stuff about chronic conditions in particular!! she waned to know all the drugs she was on and their side effects especially steroids and she was also on etanercept so u must say u give it when 2 DMARDS including methotrexate have failed hence don’t forget to ask patient if they’ve been on methotrexate ever like I did!!

• Hx Adhesions 

• History - guy with MS. Needed to elicit that his main problem was urinary dysfunction 

• Peripheral vascular disease in a man who smokes and drinks a lot!!!! Take a good social history because most of his problem list was to do with this and I spent most of my time discussing his drinking and smoking with the examiner as opposed to his PVD. General questions I got asked about PVD was investigations and management (conservative, medical and surgical). In terms of his drinking, she asked me how I would know that he has problem drinking - eye openers, interference with work and social/family life, putting alcohol above all other priorities and if he's ever been admitted into hospital with an alcohol related illness. It turns out he's on iron tablets. You are asked how this relates to his drinking - GI bleeds? 
• hx - 25year history or arterial and venous disease. Discussion of all surgical options and complications of such disease

• SAH history (Know Cushing’s response) 

• Ankle swelling history - patient was on amlodipine 

• Focused history - Chest pain - given a short case scenario of a woman who presented with epigastric pain radiating round both sides 'like a strap' worse when hungry, not on any medication. ECG and cardiac enzymes show no features of MI. - take a history and then answer examiners questions - patient had no CVS symptoms other than the chest pain, but had features suggestive of peptic ulcer disease/GORD. - examiner asked: whats ur differential diagnosis (GORD/PUD/DUD); what further investigations could you do; and what the management would be if patient had PUD (examiner stressed MEDICAL management, didnt want any conservative management! hurried me along!) Overall comment: you don't have very long to do the history so it's important to focus in on the really important things eg. does patient smoke/drink lots of alcohol/use of NSAIDS important if suspecting PUD etc.. Triple therapy for treating H Pylori
• answer questions about PUD and its aetiology/risk factors/diagnosis/management - had to ask if taking any medication over counter cos only then she said NSAIDS and paracetomol.... . // As I was leaving I was asked what it was important to rule out – said cancer and that I should have asked the patient about weight loss. The examiner asked how I would investigate this possibility and I said endoscopy. 

• Patient had rectal bleeding and history of aortic dissection, bladder cancer and angina. Asked about bladder cancer. 
• Hx - Bleeding episodes PR twice yesterday on background of weight loss and increased diarrhoea with mucous in a 59 year old lady with an aunt who has just been diagnosed with colorectal carcinoma.
• ... Writing a referral letter to hospital re: PR bleed - write referral letter to Med Reg on call regarding an urgent referral for this woman – quite tight for time. 

• Hx lady with Marfans - presented with 12 year hx of back pain. Asked diff dx, then why you get lens dislocation and mx of patients with marfans. Examiner was impressed when I said genetic counselling. 

• history - a man with hypothyroid, this was annoying - presenting complaint was just increasing tiredness. eventually got to the fact that he had carpel tunnel as well. // TATT -  History of tiredness...pt is only tired absolutely no other symptom...okay this comes up yearly n we figured that last year she had a change in her diet so you had to ask in particular have you changed ur diet...but this yr when I asked that she said no...so I asked r u a veg and she goes yes for 20 yrs she’s been a veg!!! only other problem was weight gain in past 5 months...so hypothyroid??? but examiner didn’t ask any questions so still not sure what her prob was exactly.
• History station – tiredness. She was a vegetarian, taking vitamin tablets, recent weight gain, slightly depressed. Take a full focused history, and then give differentials (main were anemia, depression and hypothyroidism), then mention to patient you will take some blood tests looking for anemia and thyroid problems and will review her later at GP // Hx - tiredness (vegetarian and swollen glands and sore throat: ?infectious mononucleosis) - told her I would ix her for anaemia, TFTs, EBV, depression hx- tiredness. // Young girl with tiredness for 2 months, some bowel problems, a viral infection a few months ago, vegetarian (but had been all her life). No heat/cold intolerance or menstrual changes. No idea. He asked what bloods I would do at the end and I said Fbc but it wasn’t until I was on the tube home that I thought of TFTs! and to keep a food diary for review

• Some weird skin condition where the patient had what looked like multiple skin tags for a history taking station (not neurofibromatosis - it was really random, but the friend of mine who had this didn't know what either of these things was and still got a distinction, so I don't think they really care that much about you getting the correct diagnosis).

• Had to take a history from a guy who had been vomiting small amounts of blood for the past two days and who had a family history of gastric cancer which he was worried about but no other symptoms. He was taking shed loads of ibuprofen for a sprained ankle. Learning point: make time for the drug history!!!
• ... 10) Referral letter for above patient. This was a strange station, we had to refer the patient we had taken a history from for further investigation, the main issue here was time and getting all the patient details down.
• History station on Gastrointestinal stromal tumour. Viva mainly on upper GI bleeds, differentials, emergency treatment etc.

• Hx – Chronic Pancreatitis – asked differential, problem list, summary etc. + causes, Ix, differences between chronic and acute
• Hx - BPH
• ... Referral for patient above via telephone - examiner kept asking what else??

• Hx - Acute shortness of breath. O/E legs for swelling - signs of tension pneumothorax and P.E management.

• Hx station - Stevens Johnsons syndrome (doesn't really matter what the Dx is - just have to take a thorough Hx and then summarise, give DDx, problem list, management plan)

• History - IHD

• Hx - crohn's disease - Dx, Rx, prognosis, aetiology etc

• Hx - perianal abscess in lady with nonspecific colitis - causes, crohns, diabetes, COPD, Qs on diabetic Cx and Ix of colitis

• My history was really hard as the patient was jaundiced, but had left abdo pain, urinary frequency and a hx of diverticulitis. I couldn't put it together but stuck to my format for the history and it must have gone OK because my score was good in the end

• History of feeling odd with frothy urine and a rash - SLE // History of gentleman with recently diagnosed hypertension (i.e. that day) and urine dip showing nephritic syndrome. Nice history of two months increasing tiredness and joint aches and spotty red rash over legs and gluteals ... Can you guess what it is yet... Two questions – most likely diagnosis and which investigations // History from a person with hypertension, with protein and blood in urine. Does not have any cardiovascular risk factors...was kinda stuck because secondary causes such as phaechromocytoma and coarctation of aorta could not be ruled out. Turned out infact patient had a rash and diffuse joint ache. Other students said the patient had SLE?? Asked what 2 investigations would you do? Answer depended on what you got out of the history, I went for renal ultrasound and ECG. // Urinalysis with nephrotic syndrome picture - history taking of hypertension, haematuria and proteinuria. - You are a GP and a patient who has just moved house had just registered- has a urine dipstick and u get given the result - ++++proteinuria and ++blood He had swollen ankles and face and a rash on shine 2/52 agon ? Nephritic sx? Asked 3 Ix would do. . 
• Think most people like me fumbled around with renal failure as most likely diagnosis and said we'd like to do U&E, FBC, glucose, creatinine clearence... and prayed for the bell to go... I said SLE, although other people think it might have been IgA - who knows? // history of (i think) glomerolonephritis secondary to SLE. He didn't question my diagnosis anyway like he did with other people who said things like pyelonephritis, nephrotic syndrome. Asked to name three tests you would do eg urine culture, microscopy, U and Es, autoantibodies for SLE

• History station - obstructive jaundice

• Hx station: very long and complicated UC history from a real patient but they just wanted to see hoe you cope with taking a complicated history.

• I had a stable patient with diabetes brought on by steroids she was on for Crohn's. Quite straightforward Others had diabetes, SLE, and there was one with gauler's disease which noone had heard of!!

• Liver transplant history

• Hx - pt with lymphoedema and median nerve compression post-radiotherapy for breast cancer
• History of a 79 year old woman with a history of breast cancer. “Please talk to this woman regarding any problems she had with this diagnosis”. More psychological rather than medical but still talked briefly (in the history and with the examiner afterwards) about triple assessment, oestrogen receptor inhibitors, staging and grading and non-medical treatments for breast cancer.

• I got SLE (I almost cried). the patient had recently been discharged from hospital with heart failure, but I asked her every question under the sun (systems review in the best!) and she was feeling very well and had no rashes or anything. She mentioned that she sometimes gets "cold fingers" and the penny dropped after that. The examiner was really nice and asked me to present my findings as a problem list. I was then asked about the features of SLE and why this patient had heart failure. I said cardiomyopathy (which I think might have been wrong) and then pericarditis/pericardial effusion (which I think made more sense). I was asked about investigations for the patient and how often I would review this patient in clinic. I said monthly for the first six months then perhaps six months. I actually was making it up.

• History: (20 mins observed + 10 mins questions) This was ridiculous. My young patient was referred to clinic with recurrent shoulder dislocations and stretchy skin. She had long complicated history involving hyperextendible joints and operations for shoulder and broken tibia, fundoplication for GORD, arthroscopies. She had osteoporosis and secondary amenorrhea because of a pituitary adenoma. On many meds - remember to ask about doses and any side effects. Diagnosis was Ehler Danlos. Differentials include osteogenesis imperfecta, Marfans, pseudoxantha elasticum. Examiner then asked questions about ED - what type of collagen affected? how would you treat? referrals? At the end the examiner said he would never have expected to see an Ehler Danlos patient in finals and that he did not feel it was fair. I did ok though!

• History – 30 minutes station, 17 minutes history, rest of time questioning by examiner. I had history of elderly man with chronic fatigue and episodes of melaena. Main differential was colon cancer. Take a FULL history, you have 5 minutes before station starts to read the scenario and write whatever questions you may want to ask so use this time efficiently to write down differentials etc before you have even taken the history. Examiner then asks you to present the history briefly and then asks for differentials, investigations and a management plan.

• Other people had a scleroderma history (shortness of breath and skin changes so know that inside out).

• Remember they like chronic diseases for histories, like HIV (nasty one as you need to know about anti retrovirals and their side effects etc), rheumatoid, SLE, IBD (UC and Crohn’s is world famous history to come up). // Hx - HIV clinic please take Hx of lady with known HIV. Turns out she has a cough, so disuses differential/management afterwards with

• hx of woman who had lung ca 4 yrs ago, had to find out how this affected her life. I was only asked questions about things I brought up. for example, when asked what investigations I would do I said fbc to start looking for high calcium - I was asked how having cancer may raise your calcium. and how on a scan they may differentiate cancer from fibrosis due to previous radiotherapy

• long hx- Mine was on thyroid cancer- initially hypothyroid, then developed thyroid cancer & Mx. A nice history in comparison to what other people got. The questioning was relatively difficult, but the doctor was very nice and there's not much you can do to prepare for it anyway

• History – took history from patient with history of several valve replacements and infective endocarditis more recently. Then asked questions by examiner on infective endocarditis and valves etc.

• Long History station - was a little baffled by this at first, the instructions were just to take a full med history from this lady, who when I asked for her presenting complaint, said 'I don't know dear, I've come in today because I always come in for exams and the doctors asked me to'. But just moved onto her PMH etc and she had a lot to go through, to which I really had to rush by the end to get a complete history! But then the 10 min discussion I just presented my case (who had diabetes, AF, OA, cancer of the breast and skin, a stroke and a few other chronic problems) and then was asked how I would manage these different parts as a GP. Again

• Hx - Patient is new to GP practice. Please take her medical history. My patient just would not stop talking and kept going off on tangents. At 17mins, I was still on HPC. Had to rush through social hx. Moral: feel free to interrupt patients!!

• History of acute cord compression and a linked station with the next one being a telephone referral (which was actually really fun!)