Sample Question

The UKFPO Clinical Assessment FP 2018 Handbook (in Appendix 1) gives us a sample question of the type of stations you might expect. I have directly copy-pasted that section.

Sample Station

This gives an example of one type of question you may encounter.

Instructions to candidate: (These are posted outside the station. You have one minute to read them. The instructions are also inside the station in case you need to refer to them again)

This is Jack Lion.
He has just arrived in the Accident and Emergency Department.
He is complaining of severe pain in the back.

Please take a brief focussed history.
The examiner will then give you the results of the physical examination.

With the information you have obtained from the history and the reported
physical examination, please explain the most likely diagnosis to the patient.
Explain to him the further investigations or procedures he needs.

Here is the background detail the simulated patient will have (please remember that you
would not normally be able to see this)
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Patient’s name Jack Lion question xx Setting A+E department sex m Timing 10 minutes age 45-55

Who are you? • You work in a food processing factory on a production line. It is very hot in the factory and they don’t allow you to take drinks in because of the risk of contaminating the food. • You live with your spouse (no children). • You have never smoked • You drink 1-2 glasses of glasses of wine each evening • You do not exercise • Your mood is normal (not anxious or depressed) • You are generally quite easy to talk to

Previous medical problems • Previously fit and well apart from mild asthma

Current health problem • You were well until the last 12 hours • You woke in the early hours of the morning with pain in your back and side • It’s on the right side of the back, just at the lower end of the ribcage. • It’s a severe pain and you cannot get into a comfortable position with it. • You tried some paracetamol and then some ibuprofen in the night, but neither helped. • Your partner was concerned about you and drove you here. • If the candidate asks you: O The pain comes and goes in waves O The pain is spreading round from the back down towards your groin and it is causing your testicles to ache. O You do not have any pain or pins and needles in your legs O You feel very sick but haven’t actually vomited yet O You feel sweaty O You noticed your urine was very dark and concentrated today – you think that’s because you’ve not been drinking enough O You have been doing a lot of overtime in the factory recently O You ate normally until last night. You haven’t eaten anything since the pain started O Your bowels worked normally yesterday, but you haven’t been today

Medical problems in the family
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• Your mother has developed a touch of arthritis in her hands and knees as she’s got older. Your father died when you were young – you don’t know the details. • If asked directly, you are aware that your brother had a kidney stone

Medication • Prescribed medication – nil • Over the counter medication – nil • Alternative therapies – nil • Allergies – nil

Feelings and concerns • You are really worried about this back pain. • You think that it could be a slipped disc as you’ve been working very hard recently • You are hoping for an x-ray to put your mind at ease. • You also need a strong painkiller quickly

Questions The examiner will intervene mid-way through the station to give the candidate the findings of the examination (they will not be examining you). Once the candidate has had time to absorb the information, ask: • What do you think the most likely diagnosis is? Why? • What other things might it be? • Do you need to organise any tests? If so, what will you will doing?

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The examiner will give you the results of the physical examination in this case (sometimes
you will be expected to perform the examination yourself)

Examination Findings

Temperature 36.9 degrees Centigrade
Pulse 110/min, regular
Blood pressure 160/70

He finds it difficult to lie still on his back.
He has some tenderness in the right loin.
All other examination findings are normal.

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The Marking Criteria (This varies from station to station. This is an example
applicable to this particular station)

Initial approach In this section the examiner will be assessing how you start off the consultation. They will be looking for a professional, respectful and sensitive approach. Don’t forget to use alcogel or wash your hands as you will be touching the patient.

Focussed history-taking The examiner will be assessing whether you are able to take a focussed and relevant history about the pain. You may need to ask some relevant questions about his background or his past medical history in order to reach the likely diagnosis

Diagnosing The examiner is assessing your diagnostic skills. Can you recognise the likely diagnosis (ureteric colic in this instance)? Can you recognise the positive features in the history and examination which lead to this conclusion? What other conditions could it be? Why are these less likely?

Initial investigations and management The examiner wants to see whether you can suggest sensible investigations, which are relevant to the particular presentation. Investigations in this case may include blood tests, urine tests and radiological investigations. The examiner also wants to see if you can plan the initial management. In this case, pain relief and intravenous access would be important considerations.

Building and maintaining relationship The examiner wants to see you display your verbal and non-verbal communication skills. Do you use these skills effectively to help the interview flow in a smooth manner? Are you sensitive to the patient’s feelings?