Station 5 and Station 2 sample      

Patient Name: Jamin,  R, a 37-year-old male from Sweden, 

presented to the Medical Assessment Unit with a skin rash. 

 

Your role: You are the doctor on duty in the medical admissions unit.

You have 20 minutes with the patient. The Examiners will alert you when 13 minutes have elapsed and will stop you after 15 minutes. In the remaining 5 minutes, one Examiner will ask you to report on any abnormal physical signs elicited, your diagnosis or differential diagnoses, and your management plan (if not already clear from your discussion with the patient.

 

Introduce yourself: My name is Dr. S, and I will be taking care of you today.

May I confirm your name and date of birth?

It is essential to confirm the patient's name and date of birth to ensure the correct patient, as there may be two patients with similar names waiting outside the clinic or medical assessment unit.  

There is no need to shake hands with the patient, for infection prevention reasons and due to some cultural considerations, unless the patient offers his hand for a handshake. 

If the patient was referred by their GP, inform them that their GP requested a consultation with me regarding their skin rash. Can you tell me more about this rash?. If he came as a self-referral, tell him, I understand that you have a skin rash. Can you tell me more about that? (open question). Open question invites patients to answer in ways that can help prevent them from feeling judged by sparking a more honest conversation. The patient usually mentions the main problem that encourages him to come to the hospital. 

 

The patient's main complaint: 

The patient reports: “I have had this rash for 3 months. It started on my hand, then spread to my shoulder, and has now involved my head and buttocks. It has been worsening over the past seven days.

 

You should ask the patient about:

The onset, how it started, does it come and go, or is it constant?

Is it itching?. Is it blistering (does it start as bubbles on the skin that are filled with fluid)?

Does it ooze or bleed?. Is it painful? Does it get affected by the sunlight?

 

Analysis of the skin rash as per the above questions 

The patient mentions that the symptoms started gradually as bubbles filled with fluid, which rupture and leak out.

There is severe itching, which sometimes leads to bleeding. Some of the lesions resemble nipples and also itch. The itching is a significant problem for me, particularly at night. The blisters and itching are constant, although they sometimes decrease in number; however, they never completely go away. After scratching, the rash discharges fluid and becomes sore. The rash is painful on sunny days.

 

 systemic enquiry 

 Fevers, night sweats, weight changes, fatigue, and headaches. 

Patient denied all of the above.

 

GIT symptoms 

The patient reports having occasional episodes of diarrhea, with loose stools 2 to 3 times per day, without mucus or blood. He sometimes feels bloated. He has never noticed yellowing of the eyes. He is not a vegetarian and has no specific food preference. He did not report mouth ulcers or dryness.   

Cardiovascular: No palpitation or shortness of breath 

Respiratory: No cough, wheezing, or chest pain

Musculoskeletal: No muscle or joint pain

Genitourinary: He passes his urine normally, with no discharge or ulcers in his genital area.      

         CNS: No weakness, numbness, or imbalance 

         No eye pain, blurred vision.

          Medical history: 

         The patient does not have any medical problems, including jaundice or risk of hepatitis 

         Medication history:

        He does not take any medication. No history of chickenpox.        

 

Allergy 

 He has no known allergies and is not wearing a watch or any jewelry. He has had no recent contact with any substances.. 

 

  Surgical history:

Tonsillectomy at the age of 11 years.

No history of hospital admission.

 

Social history 

He smokes 10 cigarettes per day and drinks occasionally.

He is married, with no history of extramarital relationships, and is the father of two boys. He does not know anything about his family's medical history, as he is adopted.

No history of recent travel. 

Patient concerns: What is the cause of this rash? Is it an allergy? 

 

Clinical Examination: Wash your hands. Inspect the distribution and characteristics of the rash. Examine the hands, check for jaundice, and assess the conjunctiva for pallor. Examine the neck for lymphadenopathy. 

Listen to the chest and the heart. 

Inspect the abdomen for the same rash. Palpate the abdomen.

Inspect the lower limbs for any rash or edema.        

 

Note: In the exam setting, it is not expected to encounter a patient with active infectious lesions. Any infectious skin lesions should be healed by the time of the exam.