Medical Council of Canada

History taking and physical examination couplet station

History taking and physical examination couplet station

This page gives you an example of a combined history-taking and physical examination station. The candidate instructions, posted outside the door of each station are also available inside the station, as well as the physician examiner’s checklist are provided. You can also view a video of an example of this type of station. At the end of the page, we list the patient-encounter probe questions and answers.

Candidate instructions

Charlotte Hanson, 55 years old, presents to your office today with abdominal pain which started last night and is slowly worsening.

Vitals signs are as follows:
Temp.: 38.0°C RR : 16/min Pulse: 94/min BP: 130/84 mmHg

IN THE NEXT 5 MINUTES:

  • OBTAIN A FOCUSED AND RELEVANT HISTORY
  • CONDUCT A FOCUSED PHYSICAL EXAMINATION BASED ON THE HISTORY

As you proceed with the physical examination, EXPLAIN TO THE EXAMINER what you are doing and DESCRIBE ANY FINDINGS.

  • After the 5-minute warning buzzer, the examiner will ask you one brief question about this patient.
  • At the next station, you will be asked to answer questions about this patient.
  • GIVE TWO (2) LABELS TO THE EXAMINER.
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Video example

What the examiner completes

Examiner’s checklist

The examiner must fill in the bubble for each item completed satisfactorily.

1. Elicits history of pain
– location
 o – intensity
 o – character
 o – pattern
 o – radiation
 o – exacerbating factors
 o – relieving factors
 o – previous similar episodes
 o – nausea OR vomiting
 o – sweating
2. Elicits GI/GU history
– last bowel movement
– character of recent bowel movements
– pain with urination
– blood in urine
– urgency/frequency with urination
– sexual activity
– last menstrual period OR menopause
– vaginal discharge or bleeding
3. Elicits medical history
 – current medications
 – past significant medical OR surgical history
 – family medicine history
 – substance abuse
 4. Conducts a focused physical examination
 – inspects abdomen for scars, pigmentation, symmetry, distension, etc.
 – auscultates in all 4 quadrants
 – percusses in all 4 quadrants – working from least tender to most tender
 – palpates in all 4 quadrants – working from least tender to most tender [Do not need to palpate all four quadrants if bowel sounds are heard at the first site auscultated.]
 – assesses for signs of peritoneal irritation [ANY of: guarding, percussion/rebound tenderness, psoas sign or Rovsing sign]
 – indicates need for genital/rectal exam (Examiner to say: “The exam is normal, please move on.”)
5. Question to be asked ORALLY by the examiner after the 5-minute warning buzzer
 What is your diagnosis?
 – appendicitis

 

INTERACTION RATING SCALES
1. Overall Organization of Patient Encounter [ONE bubble only]
No logical flow; scattered, inattentive to patient Counsels patient before taking history or doing physical Minimal organization; scattered approach Appropriate approach to patient Skillful approach to patient Skillful, professional approach to patient and effective use of time
2. Attention Given to Patient’s Physical Comfort [ONE bubble only]
Exam not attempted, or inattentive to patient’s comfort or dignity (e.g., no draping, causes pain unnecessarily) Causes some unnecessary discomfort or embarrassment Borderline unsatisfactory in attending to patient’s comfort and needs Borderline satisfactory in attending to patient’s comfort and needs Mostly attentive to patient’s comfort and dignity Consistently attentive to patient’s comfort and dignity
MCCQEII Patient-Encounter Probe (write-in)

1. What are the THREE most important features of this clinical presentation that support the diagnosis you provided in the previous station? [Maximum of THREE answers]

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2. What TWO OTHER differential diagnoses have you considered? [Maximum of TWO answers]

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3. What is THE next step in the management of this patient? [Maximum of ONE answer]

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