Simulated Patient Brief — MO (Pneumonia)
Location: Accident and Emergency. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Mo
- Age
- 70 years
- Opening statement
- “I’ve had this chesty cough for two weeks — the antibiotics haven’t helped and I feel terribly ill.”
You first noticed a chesty cough 2 weeks ago. Your GP said you had a chest infection and started antibiotics. You have been taking them for 5 days and things have not improved; symptoms have worsened over the past couple of days, which is why you came to A&E.
Response to questions
- Open questions: describe the two-week course and that you feel terribly ill despite antibiotics.
- Offer only when asked:
- Cough: very chesty; thick yellowish/greenish sputum; worse over the past few days. No blood.
- Chest pain: started a few days after seeing the GP. Sharp, with inspiration and expiration, right side of chest quite low down, also felt in the back. Not worse on movement or when the ribs are touched.
- Fever: yes — hot and cold with shivers; started recently.
- Breathlessness: worse over the past couple of days; very tired. Normally active for your age. Last night breathless walking upstairs; this morning breathless just walking around the house.
- Appetite poor; forcing small amounts of water. Passing less urine (thinks due to drinking less). Last opened bowels 3 days ago. No recent overseas / long-haul travel if asked.
Ideas: You know your chest is getting worse and you feel very unwell. You are not sure why — the GP said you should start to feel better after a couple of days of treatment.
Concerns: Worried about how unwell you feel this morning. You “just don’t feel right.” The breathlessness and pain are frightening.
Expectations: Confirm what is wrong and change treatment. You would like a chest X-ray. You wonder if you need to be admitted.
- Hypertension for several years — well controlled
- “High cholesterol” for several years — well controlled on tablets
- Amlodipine (hypertension)
- Atorvastatin (cholesterol)
- Just completed 5 days of amoxicillin — if asked, think the dose was “500”, one tablet three times a day
- No known drug allergies
- Mother died from ovarian cancer in her 50s
- Father still alive, nearly 100, reasonably good health
Partner died 5 years ago from a heart attack; no current partner. Retired 5 years ago from a mortgage-broker firm (20 years there); loss of partner prompted retirement. One grown-up son in Germany with family; they visit often; two grandchildren. Do not drink alcohol and have never smoked.
Systems review: reply in the negative to any other symptoms.