😀 EASY

Thanks for coming to the lectures – or for viewing them online.

These were two in-person lectures for the Warwick Medical School “Clinical Skills Society” delivered in October of 2021. Due to social distancing, we gave two presentations simultaneously to different audiences, and as there were a few differences in what we chose to focus on and discuss we wanted to make them both available to the students who attended, as well as to the wider community.

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This tweet got more than 20,000 views from #MedTwitter within 24 hours of posting. As of October 5th, 2021, it also had 105 comments from doctors and healthcare staff all over the world Check it out for many wonderful tips!

  • Outline how the medical history fits into the broader theme of the patient journey 
  • Outline how to structure a general medical history (eg using the Warwick Medical School “Four Frames” approach) 
  • Outline how to focus the general history, once the history of the presenting complaint has been elucidated 
  • Outline how to take a pain history of the presenting complaint 
  • Outline the tenants of a past medical history, drug history and allergies 
  • Outline how to take a social history 
  • Outline “ICE” in the OSCE setting 

history taking introduction

Congratulations - you have completed history taking introduction. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
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Question 1

Stem

A 65 year-old male presents with heartburn.  He says its worse when he has a warm cup of tea, and describes the sensation as a 4 out of 10 for pain.  He drinks 13 units of lager a week, and has smoked 20 cigarettes each day for 10 years.  His weight is 92Kg, he is 1.85m tall.  On examination, he has no peripheral stigmata of disease, except elevated body habitus and does not appear distressed.

Which system would you most-likely want to “click” into first, during the first frame?
A
Cardiology
B
Respiratory
C
Neurology
D
Obstetrics
E
Gastrointestinal
Question 2
Calculate the patient’s pack year history of smoking
A
5 years
B
10 years
C
15 years
D
20 years
E
25 years
Question 2 Explanation: 
Pack years are easily calculated: (number of cigarettes/20) * years smoked. Ergo, ((20/20)*10) = 10
Question 3
Calculate the patient's BMI
A
23
B
24
C
25
D
26
E
27
Question 3 Explanation: 
BMI = weight/height^2 = 92/(1.85^2) = 26.88
Question 4
Given the previous answer, what classification does this place the patient in?
A
Underweight
B
Normal weight
C
Overweight
D
Obese class I
E
Obese class II
Question 5
How many units does the UK Chief Medical Officer (CMO) advise is the upper limit of drinking per week?
A
10
B
12
C
14
D
16
E
18
Question 6
What is the minimum number of days the CMO recommends spreading out weekly drinking over?
A
2 days
B
3 days
C
1 day
D
There is no recommendation
E
Always more than 5 days
Question 7
What is the most likely diagnosis of this patient?
A
Acute coronary syndrome
B
Aorta aneurysm
C
Cholecystitis
D
Achalasia
E
GORD
Question 8
Which of the following features are more likely to support the previously hypothesised diagnosis?
A
Positive barium swallow
B
Abnormal chest X-ray
C
Family history of reflux
D
Improvement of pain on lying down
E
Improvement of pain on taking ibuprofen
Question 9
Define the term momentum bias
A
The tendency to be influenced by what someone else has said to create preconceived idea.
B
The tendency to search for or interpret information in a way that confirms one's preconceptions
C
The unconscious tendency to be favorably biased toward people like ourselves
D
Using a too-narrow approach and description of the situation or issue.
E
Once a diagnostic label has been assigned to a patient by another individual, it is very difficult to remove that label and interpret their symptoms with fresh eyes
Question 9 Explanation: 
In order: 1) Priming bias 2) confirmation bias 3) affinity bias 4) framing bias and 5) momentum bias (aka "diagnostic momentum"). Thanks Wikipedia and First10EM for definitions.
Question 10
Gastro-oesophageal reflux disease is primarily caused by a deficit of function from which structure?
A
Epiglottis
B
Upper oesophageal sphincter
C
Lower oesophageal sphincter
D
Gastric cardia
E
Gastric body
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