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This is a long case.

Please take a history and conduct an appropriate examination. The observing examiner will give you specific examination findings and the results of your initial investigations on request.

Discuss your differential diagnosis and negotiate a management plan with Kirrilee.


Kirrilee is a 23-year-old fashion designer. She presents to you with a three-week story of abdominal pain.

She is a new patient at the practice and so no past medical history is available.


You are a 23-year-old fashion designer. You live with your female partner, Natalie, who is a nurse.

In the last three weeks you have had abdominal pain. At times the pain is severe. Since the pain started, you have needed to rush to the toilet, and have been passing loose bowel motions at least three times a day. On a couple of occasions, you have been woken from sleep with pain and a need to pass bowel motions. Last week you noticed some blood mixed in with the stool and that was when you decided to make a doctor’s appointment.

You feel the pain in your right iliac fossa. It is worse after you eat.

You are nauseated but have not vomited. You have lost your appetite and have two painful ulcers in your mouth. You have lost 2 kg in weight and feel weak. You have not had fevers.

Your periods are generally regular and non-painful. Your last period was last week and normal. There is no vaginal discharge. You have no dysuria, frequency or haematuria. You have no history of any eye issues or joint pains.

You work in the city as a fashion designer. You and Natalie have been together since you met at university.

You have never smoked. Most Saturday nights you drink four to five glasses of wine.

You recently visited your brother on the central New South Wales coast but have not travelled overseas.

  • Medication

  • Nil prescribed

  • A friend gave you ginger tablets from the herbal shop but they had no effect, nor did the ranitidine or antacids that you bought from the chemist

  • Allergies

  • You have no allergies

  • Family history

  • Both your parents are alive and well

  • Clinical examination findings

  • Tenderness without guarding to be demonstrated in the right iliac fossa.


Clinical examination findings

To be given if requested/examination demonstrated:

Temperature 37.0°C

Hands normal

BP 114/80 mmHg

Pulse 64

Height 171 cm

Weight 76 kg

BMI 26 kg/m2...

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