History-taking couplet station example
What the candidate reads
Candidate’s Instructions
Luc Léger, 59 years old, presents to your office complaining of jaundice.
In the next 5 minutes, obtain a focused and relevant history.
At the next station, you will be asked to answer questions about this patient.
What the examiner completes
Examiner’s Checklist Fill in the bubble for each item completed satisfactorily |
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1. |
Elicits onset/duration |
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2. |
Elicits progression |
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3. |
Elicits associated symptoms |
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- dark urine |
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- pain |
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- color of stool |
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- fever |
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4. |
Elicits risk factors |
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- previous exposure to hepatitis |
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- recent blood transfusion |
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- intravenous drug use |
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- foreign travel |
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5. |
Elicits an alcohol use history |
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6. |
Conducts a review of systems |
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- skin |
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- gastrointestinal |
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- weight loss |
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- change in appetite |
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Did the candidate respond satisfactorily to the needs/problem(s) presented by this patient? |
If unsatisfactory, please specify why: |
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Satisfactory
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Unsatisfactory
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Do you have concerns regarding this candidate's ethical and/or professional behavior? |
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What the candidate receives
Post-Encounter Probe
Q1. The abdominal examination of Luc Léger revealed no organ enlargement, no masses and no tenderness. What radiologic investigation would you first order to help discriminate the cause of the jaundice?
______________________________________________________Q2. If the investigations revealed that this patient likely had a post-hepatic obstruction, what are the two principal diagnostic considerations?
- ____________________________________________________
- ____________________________________________________
Q3. What radiologic procedure would you consider to elucidate the level and nature of the obstruction?
______________________________________________________Q4. If this patient were found to have a cancer localized to the ampulla of vater, what single treatment would you recommend?
_____________________________________________________
What the post-encounter probe marker receives
Answer Key |
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Q1. |
The abdominal examination of Luc Léger revealed no organ enlargement, no masses and no tenderness. What radiologic investigation would you first order to help discriminate the cause of the jaundice? |
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Score |
A1. |
Abdominal (liver) ultrasound |
4 |
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Endoscopic retrograde cholangiopancreatography (ERCP) |
2 |
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Maximum |
4 |
Q2. |
If the investigations revealed that this patient likely had a post-hepatic obstruction, what are the two principal diagnostic considerations? |
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Score |
A2. |
Pancreatic (periampullary) cancer |
2 |
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Choledocholithiasis |
2 |
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Gallstones |
1 |
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Maximum |
4 |
Q3. |
What radiologic procedure would you consider to elucidate the level and nature of the obstruction? |
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Score |
A3. |
Endoscopic retrograde cholangiopancreatography (ERCP) |
4 |
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Percutaneous trans-hepatic cholangiogram (PTC) |
4 |
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Computed tomography (CT) scan |
1 |
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Hida scan (biliary) |
0 |
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Liver scan (Technetium 99M labeled sulphur colloid) |
0 |
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Maximum |
4 |
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Q4. |
If this patient were found to have a cancer localized to the ampulla of vater, what single treatment would you recommend? |
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Score |
A4. |
Whipple procedure (pancreatic-duodenectomy) |
4 |
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Biliary bypass |
2 |
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Excision |
1 |
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Chemotherapy |
0 |
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Radiotherapy |
0 |
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No treatment |
0 |
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Maximum |
4 |
