Name: Thomas Anderson

DOB: DD/MM/YYYY

Age: 62

• Obviously worried, want to see a specialist not a junior doctor
• You want an expert opinion -- with the right attitude from candidate you can be persuaded to let junior doctor help you first

• I: You think this is a heart attack, you remember your father having similar symptoms
• C: Your main concern is the pain -- you wish to have this relieved as it is making you very anxious
• E: You want the pain to be relieved as soon as possible

• Your work colleagues called an ambulance as you have severe central chest pain that started an hour ago. Throughout the consultation you are clearly distressed

Positive symptoms:

• Pain:
  
  • Centrally located pain
  • Started whilst sat at office computer
  • Heavy squeezing chest pain
  • Feeling short of breath
  • Radiating to left shoulder
  • Sudden onset
  • 9/10 severity in 30 minutes
  • Pain has eased since -- still in discomfort
  • Nauseous in the morning, did not eat breakfast
  • No vomiting
  • Thought it was indigestion from heavy meal previous night
  • Not feeling right since waking up
  • Not relieved/exacerbated by change in position
  • No medication taken

Negative symptoms:

• No coughing blood
• No wheezing
• No fevers
• No weight loss
• No leg swelling
• No tingling

• GORD
• Diabetes type 2
• Hypertension
• High cholesterol
• No surgical Hx

• Omeprazole
• Metformin
• Amlodipine
• Statin
• No over the counter medications
• No known drug allergies

• Father had a heart attack in his mid 50s -- heavy smoker
• High cholesterol in family -- even sister who follows strict diet

• Stopped smoking when father passed away 10 years ago
• Prior to that smoked average of 30 a day for 30 years
• Drink minimal alcohol
• No recreational drug use
• Sedentary lifestyle -- spend most time sat at office desk
• Stressful accountant job
• Healthy diet which helps with GORD
• Often eat fatty foods due to work
• Live with wife -- fit and healthy
• 2 sons live abroad