Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a Foundation Year 2 doctor on placement at GP. Your next patient is Alison Lockwood, a 20-year-old university student complaining of abdominal pain. Please take a history and perform a relevant examination.
Patient History:
You noticed a dull generalised abdominal pain that started in the past week. It is gradually getting worse. It does not radiate. The pain is not worsened/improved with eating or defecation. Pain score 6-7/10.
You also noticed diarrhoea starting 3 days ago, passing 4-5 loose and “mucusy” stools daily, but no blood. Stools are not particularly foul-smelling. You have lost around 1-5 kg over this period. Similar episodes have come and gone repeatedly for the past year. You are well between episodes, but feel very low and run-down during episodes. You also have a sore mouth, but you've had frequent mouth ulcers since childhood. You feel feverish but haven’t taken a temperature yet.
You cannot recall eating anything troublesome before this, but generally, you eat a low-fibre and highly processed food diet. No recent antibiotics, hospital admissions or foreign travel. No nausea/vomiting, dysphagia, jaundice, weight loss, or fever. No joint pains or skin rashes.
Ideas, Concerns, Expectations:
You think you might have IBS, which your flatmate also has. You're worried you might have caught this from her and about the impact this pain has been having on your university studies, and you want to know how long the pain will take to resolve (ask the doctor directly).
Past Medical History:
Fit and well.
Drug History:
None.
NKDA.
Family History:
You recall your mother had a similar problem but can’t remember exactly what caused this. You have a family history of diabetes (not sure which type).
Social History:
You are a university student studying interior design.
You live with your flatmate.
You smoke 5-10 cigarettes daily and drink 2-3 units per week.
Examination Findings:
Oral aphthous ulcers
Generalised abdominal tenderness with no guarding.
Tender, red, raised nodules on the shins consistent with erythema nodosum
PR examination may elicit pain and reveal perianal lesions e.g. fistula, skin tags, abscesses…etc.
Differentials:
Inflammatory bowel disease (Crohn’s disease most likely)
Gastroenteritis
Irritable bowel syndrome
Coeliac disease
To rule out causes of acute abdomen e.g. appendicitis, bowel obstruction, pancreatitis, perforation…etc
Investigations: