INSTRUCTIONS FOR THE DOCTOR
Please take a history from Kerrie and conduct an appropriate focused clinical examination. Outline your differential diagnosis to the facilitator.
Kerrie Griffiths is a 32-year-old woman whose first child was born by caesarean section a week ago. Baby Eloise is doing fine and Kerrie was discharged home yesterday.
This morning Kerrie has noticed a sharp pain on the left side of the chest. The pain is worse on breathing in. You are called to see Kerrie at home.
The following information is on her medical record:
INSTRUCTIONS FOR THE PATIENT, KERRIE GRIFFITHS
You are 32 years old and your first child was born by caesarean section a week ago. Baby Eloise is doing fine and you were discharged home yesterday. This morning you have noticed a sharp pain on the left side of your chest. This is worse on breathing in and you feel short of breath. You have asked the doctor to see you at home.
This is a new pain. It is preventing you from breathing comfortably. You have had a cough this morning and have coughed up a bit of blood. You do not have a temperature and do not have any pain or symptoms suggestive of a deep vein thrombosis in your legs. You are breastfeeding without difficulty.
The following information is on your medical record:
Clinical examination findings
When the doctor examines you, please tell them the following:
You will experience pain in your left lower lobe on inspiration and be reluctant to take deep breaths
Legs are normal (the most likely diagnosis is that you have a pulmonary embolus).
SUGGESTED APPROACH TO THE CASE
Ask after the baby, feeding, sleep etc.
Open questions to explore Kerrie’s ideas, concerns and expectations.
Check for haemoptysis, dizziness, syncope, shortness of breath
Enquire about asthma control
Exclude infection as likely cause—ask about fever, systemic upset
Past history of thromboembolism or known thrombophilia disorders