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Mark Scheme

Station 1

You are a physician associate working in A&E and you have been asked to assess this breathless patient. 


  • Take a focused history 

  • Give the patient your working diagnosis

  • Discuss management plans with the patient 

Name: Miles Connor

Age: 68

Occupation - Real Estate Agent


You have arrived at the A&E with your wife after having difficulty breathing. This has only been lasting for the last hour and a half and appeared to have occurred suddenly. You have felt quite short of breath before but never like this. Your wife was more concerned than you were and decided it was best  to come to A&E. If asked about any pain, inform the candidate that you do feel pain in the left side of the chest. If the candidate asks you if there’s anything that worsens the pain; report when inhaling deeply. Describe the character of the pain as sharp. Pain lasts for half a second and is relieved on expiration. Despite using your blue inhaler 7x, shortness of breath has not improved. Deny any cough or fever. Also deny wheeze or difficulty sleeping at night/lying down due to SOB. If directly asked by the candidate about any calf pain or swelling, reluctantly reply dull ache and swelling in the left calf which you believe may be a result of advised bed rest for the last two days. If explored further by the candidate reveal recent right hip replacement two days prior.

Deny any nausea, vomiting, sweats, clamminess, loss of consciousness or dizziness.

You are convinced that this is probably your asthma playing up, as you have not been active in the last week. Your concern is the blue inhaler not working as it used to despite having well-controlled asthma for the last 50 years, and if there is other medication that you should take in emergency situations such as this.


Past Medical history


Chronic kidney disease


Drug history


Atorvastatin 20mg

Losartan 50mg   

*allergy to penicillin - hives*


Past Surgical history

Total right hip arthroplasty – 2 days ago

Social history

Current smoker (20-25 cigarettes/day for 50 years)



Family History

Mother died of major stroke age 65

Father died of a heart attack 70 years old





History of presenting complaint

Explore respiratory related symptoms

System review

Past Medical History

Drug History

Social History

Family History







Your Score

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