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Standardized Patient Report Page 1

The University of Miami Miller School of MedicineDivision of Hepatology

Standardized Patient Report

Case Overview: The name of the disease is Echinococcus Granulosus and it is a cystic tapeworm that is

prevalent in sheep in South American regions. Humans contract it when they come in contact with animals, specifically dogs and sheep, who have it. Sometimes symptoms of the disease will not show up for 5-15 years. You as an actor will portray the relative symptoms listed below, focusing specifically on the spreading rash and your upper abdominal discomfort. You felt the abdominal pain start about two weeks ago but it became more serious around three days ago. If the doctor asked you to rate your pain on a scale 1-10, you would say it’s about a 7.5 now. Also, you have never had hives before.

● Symptoms ○ Cysts located most often in the liver and lungs○ Nausea and vomiting○ Fatigue○ Unintentional weight loss○ Feeling of pressure on surrounding tissue○ Hives

For further information on the disease you will be acting out visit: http://health.utah.gov/epi/diseases/echinococcosis/factsheet.pdf

Lifecycle ofparasite:


Patient Background:

Your name is Franchesca Garcia, you are 25 years old, and currently live in Fort Lauderdale, Florida. Your occupation is a grade school teacher at a school that teaches in both English and Spanish and you have been teaching there for two years. You love your job and are so happy that your passion for Spanish culture can be exhibited everyday. You graduated from Central Florida University (Go Knights!), majoring in Secondary Education and minoring in Spanish. One of your favorite college memories is studying abroad in Peru during your second semester of Sophomore year. You were lucky enough to stay with host parents that raised sheep and had three dogs, which made you ecstatic since you love animals.

You enjoy going to the beach and love dogs. You have two of your own named Gerald and Star. Both are Australian Terriers and adorable. You want to travel everywhere, but need to work to get money (being an adult is hard), and also like to stay by your aging parents, Stacy and Ryan, who live nearby in Coral Gables, which is just about 45 minutes away in Miami. You never want to move away from Florida and you hope you can keep your teaching job there for as long as you can. Your two older brothers, Josias and Raul, moved away so now it is just you and the aging parents. You really wish you could see them more since Raul and his wife just had a baby boy, but you are looking forward to when they come and visit again.

Work keeps you very busy, but you still make time for some friends. They enjoy doing the same activities you do, but don’t love dogs quite as much. You have never had a serious romantic partner, but are contemplating making a Tinder. Both your family and friends say you have been single for too long.

Lately you have been feeling very tired and lethargic so you have been trying to work out more to get energy. Surprisingly you are losing weight! However, you didn’t really want to lose weight, and can’t seem to get the pain in your abdomen to go away. It has spread and gotten worse recently, and is currently so bad you needed to take off work and have needed your parents to help take care of your dogs.This also saddens you since you hate hiring a sub to fill in for your teaching job. Due to this you went into the emergency room at Plantation General Hospital, where the doctor told you it was likely caused by a liver problem you can’t remember the name of. You luckily got an appointment the next day, and here you are. You want to finish the appointment quickly to get back home and sleep, but more importantly you want to find out what is wrong.

Standardized Patient Report Page 3Medical History:

● When you were six years old you broke your tibia (oblique fracture) while playing with your brother Raul on your family swingset.

● When you were fifteen doctors were alarmed when your lower right side hurt. They told you that it was your appendix but was not serious enough to remove since surgery could lead to more complications at the time.

● No history of allergies ● Wisdom teeth were taken out when you were seventeen

Family Medical History:

● Your father and mother both have high blood pressure but you have never shown any signs of it

● You’re Aunt Gretta on your mom’s side has cataracs● Both brothers are fairly healthy, Josias has asthma but just uses an inhaler when

needed

Medication History:

● You also have taken aspirin and zyrtec recently to stop the pain and help with the hives but nothing seems to be working.

● Topical treatment of cortisol has also not worked in stopping the rash. ● Took Vicodin when you had wisdom teeth removed

Allergies:

● None

Diet:● Conscientious of health● Eats a balanced assortment of foods● Gets fresh fruit and vegetables from local market● Prefers to eat gluten free if possible● Does not drink soda● Limits sugar intake as much as possible● Enjoys the occasional glass of wine


Encounter Dynamics:

● You generally maintain a happy disposition● Naturally you like to talk about topics that you are passionate about● You answer questions attentively● Look directly at doctor and do not look hesitant● Although you loved your travel experiences abroad, you never voluntarily bring

them up since you know traveling is a not a current priority but you wish it could be.

● You are very adamant about addressing the concern the emergency doctor mentioned surrounding your liver. You keep pressing this topic within the conversation.

● If asked if you ever traveled abroad, answer truthfully but brush off the question since it was a few years ago.

Physical Presentation:

● Dressed neatly and professionally● Maintains clean hygiene ● Wearing light long sleeve shirt to cover hives● Hives covering arms and leading down to chest and abdominal area (not visible)● Continuously hold your stomach, including when the doctor walks in.● You will not be asked to disrobe.

Props: ● Brings in phone with intent of showing the doctor pictures of her dog if they

become mentioned in the conversation. ● There should be no bandages or scars needed ● Light long sleeves covering the hives

Opening Line:

● “Do you think these hives could be caused by my liver problem the Emergency Room doctor mentioned? I just really want to know how quick I can get back to normal because I really don’t want to get a sub for my classes tomorrow again.”

Habits:

● Likes to go for morning walks with her dogs● Keeps track of steps per day on your FitBit ● Organizes almost every facet of life in a planner● Goes to local Planet Fitness periodically

Standardized Patient Report Page 5● Redecorates classroom and house for every month● Writes a teacher’s blog for the Miami Herald

Specific Questions and Answers:

● If doctor asks if you have been out of the country recently respond by saying, “I haven’t been abroad in ages, but during college I studied abroad in Peru. But that was ages ago.”

● Ask the doctor “Is it normal to be losing a lot of weight by just sometimes working out?”

● Ask, “Could there be a reason that I am losing my appetite? I hardly ever feel hungry anymore”

● If the medical student questions your energy levels, answer by stating “I wake up everyday feeling more and more tired, even if I slept in all day.”

● If asked about hives, state that you find them extremely unpleasant to look at, and they are extraordinarily itchy

● If asked about the pain, respond that it is a 7.5 in the main area (over the liver), and is sharp like getting stabbed. The area around it (upper abdomen) hurts less but is more constant and feels pressurized, as if someone were blowing up a balloon.

● If further asked about your experience abroad, tell the doctor the family had a few dogs, and if they ask about other animals tell them the family had a herd of sheep they raised.

Tests Which Could Be Ordered to Diagnose Condition● MRI● X-ray

● Both of these tests show distinctly the cystic parasitic growth in the liver and possibly surrounding tissues, and if the med student orders one be sure to ask why it is needed, as one goal is that they suspect a parasite, not just a liver disorder.

● Asking them explain the procedure if the tests show a parasite is important in the scenario, as the most common way to remove the cysts is through surgery.

● If surgery is brought up, ask how long it will be and if you will fully recover.


Area to point out specifically where pain is the worst:

Patient Chart:

Name: Francesca Garcia


Sex: Female

Age: 25

Chief Complaint: Patient has spreading hives and general lower abdominal pain.

The emergency room doctor thought it might be liver cirrhosis and recommended her to go see further treatment for it.

Vitals have been taken:● Blood pressure: 96/63 mm Hg ● Breathing: 15 breaths per minute.● Pulse: 77 beats per minute.● Temperature: 99.1°F

You have ten minutes to do an examination of the patient’s major reason for visiting.

Then, spend ten minutes filling out appropriate paperwork and ordering any appropriate tests.

Return for ten minutes to instruct and counsel patient further

Medical Student Evaluation:

Please answer these questions based on the 1-5 scale:

1. Effective Eye Contact


Meets Expectations Needs Improvement Unsatisfactory

5 4 3 2 1

2. Verbal Communication (Tone, Pace, Volume, Smooth Transitions)


5 4 3 2 1

3. Appropriate Body Language


5 4 3 2 1

4. Appropriate Language (Professional and no inappropriate medical jargon)


5 4 3 2 1

5. Use of Questions:


5 4 3 2 1

6. Facilitated Conversation:


5 4 3 2 1

7. Appropriate Introduction


5 4 3 2 1

8. Determines Patient Knowledge


5 4 3 2 1


9. Asks About Medication Regimen


5 4 3 2 1

10. Counseling and Informative on Patient’s NeedsMeets Expectations Needs Improvement Unsatisfactory

5 4 3 2 1

11. Closing Statements:Meets Expectations Needs Improvement Unsatisfactory

5 4 3 2 1

12. Ordered either MRI or X-ray to Assess ConditionMeets Expectations Needs Improvement Unsatisfactory

5 4 3 2 1

Further Comments:

Would you go back to this specific doctor? Yes or No

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bloggerbaileyblog.files.wordpress.com · Web viewThe University of Miami Miller School of Medicine. Division of Hepatology. Standardized Patient Report. Case Overview: The name