Candidate Instructions 🧒

You are the FY2 working at a GP.

Your next patient is Mrs Mary Jane, a 70-year-old lady who has come in with worsening constipation.

Please elicit a focused history, offer your differentials, investigations and discuss next steps in management.

Station Material (ONLY OPEN WHEN PROMPTED)

There are no station materials for this station

Actor Instructions 🤒

Name: Mary Jane

DOB: DD/MM/YYYY

Age: 70

Agenda:

You do not like to go to the doctors unless it is very severe, as you are worried of taking up their time, you don't really think that you have anything severe but your daughter urged you to see a doctor.

ICE:

I: You think the pain has started because of the constipation
C: You are not worried about anything in particular
E: You wish for the doctor to prescribe something very strong to help you move your bowels

PC:

You have been finding it increasingly difficult to go to the toilet, you have also been struggling with pain on the right on your tummy, and you think the two are related

HPC:

Positive symptoms:

Last moved your bowels one week ago -- a lot of straining
Normally move bowels 1 per day
Hard faeces, small ball-like
Symptoms going on for past 2 months
Never seen blood in stool

Pain:

     - Strongest on your** right hand side**, towards the **bottom of your tummy** 
     - Pain started **3 weeks ago**
     - Severity **6/10 -- 9/10 **on occasion (no pattern)
     - Last multiple hours somedays
     - **No radiation**
     - Associated with **nausea** NEVER vomited
     - Paracetamol does NOT help -- NO opioid analgesia used
     - Settles after a few minutes usually 
     - Pain has become **increasingly frequent**

Negative symptoms:

No change in appetite -- opt for more frequent, smaller portions recently, drink plenty of fluid
Feel full with smaller quantities recently
No bloating/distension
No weight change
No fevers or night sweats
No yellowing/itching of skin
No fatigue
No rashes or joint pains.
No symptoms concerning other body systems eg: urinary changes, headaches, chest pain, cough, sensorymotor changes, focal neurology, etc.

Obs & Gynae Hx:

Total hysterectomy due to large fibroids in 40s -- ovaries NOT removed
Daughter born by vaginal delivery
Never on contraception or HRT
First period relatively early compared to peers, and went through the menopause at age of 50
Never had an STI

PMHx:

Hysterectomy in early 40s
Skin surgery on the nose to remove a malignant mole
High blood pressure
High cholesterol
GORD

DHx:

2 medications for blood pressure management -- cannot remember names
Statin
Omeprazole
No laxative use

FHx:

Mother died from ovarian cancer in her 60s
Daughter has fibroids
No other family history of note

SHx:

Smoked 30 a day for 35 years stopped 10 years ago
Drink 1 glass of wine per night
Live alone -- husband passed away about 5 years ago
Daughter lives nearby and visits regularly to bring groceries
No change in your diet -- you had a poor diet when you were younger
Retired nurse
Do not drive
Increased frequency of the painful episodes - have not left the house much

Constipation 1

Candidate Instructions 🧒

Station Material (ONLY OPEN WHEN PROMPTED)

Actor Instructions 🤒

Name: Mary Jane

DOB: DD/MM/YYYY

Age: 70

Agenda:

ICE:

PC:

HPC:

Positive symptoms:

Negative symptoms:

Obs & Gynae Hx:

PMHx:

DHx:

FHx:

SHx:

Mark Scheme ✍️

Introduction

Presenting complaint

History of presenting complaint

Pain

Gastrointestinal symptoms

Systemic symptoms

Gynaecological history

Past medical history

Drug history

Family history

Social history

Conclusion

Diagnosis

Differential diagnoses

Investigations

Bloods

Further investigations

Management