Name
Lindy Barlett
DOB
02/12/1991 (23 years)
Occupation
Cartoonist
History
I have had blood mixed in with my stool for 2 weeks. It is around 2-3 tablespoons of murky blood with bits of mucous in it each time I pass stool. It has got worse from the last time it occurred 2 months ago, where it was less blood but still around 2-3 weeks. My stool has also been runnier but has some lumps. I have also found myself going more frequently, up to 3 times a day whereas I used to go once a day at most. I cannot think of any triggers or any particular foods which worsen or improve my symptoms. It's a little uncomfortable but not too painful. I have lost around 4kg in weight. I deny any nausea or vomiting. I have not been in contact with anyone unwell or travelled abroad. just feel unwell with a slight fever and stomach upset. No other symptoms including no joint pain, rashes or eye symptoms. I know that this is cancer and I should've got it checked earlier because I looked up my symptoms online.
Past Medical History
Nil
Drug History
Nil. No recent antibiotic use or use of laxatives. No known allergies.
Family History
Mother has psoriasis. Nil else
Social History
Smoking 20 cigarettes per day. No alcohol or recreational drug use. No recent travel

Introduces self
0
1
Confirms name & age of patient
0
1
Explains reason for consultation & builds rapport
0
1
Gains consent
0
1
Asks open question
0
1
Clarifies that it is not haematuria or vaginal bleeding (if female)
0
1
Clarifies whether blood is mixed in with stool, around the stool, dripping from the anus or on tissue paper
0
1
Establishes duration and trigger (if present)
0
1
Establishes character: fresh, dark/melaena, liquid/clots, mucus, smell
0
1
Establishes amount and frequency
0
1
Establishes time course (worsening, continuous, intermittent)
0
1
Asks for alleviating or exacerbating factors (specifically dietary, constipation, anal intercourse, foreign bodies)
0
1
2
Asks for associated pain, itching, tenesmus, lumps/piles, prolapse, change in bowel habit, abdominal pain
0
1
2
Asks for IBD symptoms: red eye, joint pain, skin lesions, oral ulcers, bloody diarrhoea
0
1
Establishes if symptoms of anaemia are present: lethargy, palpitations, shortness of breath
0
1
Identifies any red flags: haematemsis, weight loss, loss of appetite
0
1
Asks for any recent illness, bleeding from elsewhere or any family members/contacts with similar symptoms
0
1
Elicits past medical and surgical history (specifically previous rectal bleeding or disorders, bowel disorders)
0
1
Asks for any recent foreign travel
0
1
Elicits family history (specifically asking for colon cancer, polyps, angiodysplasia, inflammatory bowel disease)
0
1
Elicits drug history (specifically NSAIDs, warfarin or other blood thinners)
0
1
Checks for allergies
0
1
Checks if patient smokes or drinks
0
1
Asks if any history of illicit drug use
0
1
Checks impact of symptoms on occupation
0
1
Explores and responds to ideas
0
1
Explores and responds to concerns
0
1
Explores and responds to expectations
0
1
Shows empathy
0
1
Avoids jargon
0
1
Summarises back to patient
0
1
Thanks patient
0
1
Patient global score
0
1
2
Gives reasonable differential diagnosis (Inflammatory bowel disease, Infective gastroenteritis, Polyps)
0
1