Name
Jacob Johnson
DOB
05/12/1971 (44 years)
Occupation
Tax inspector
History
I look and feel quite low. My co-worker mentioned that my eyes look yellow and asked if I have been getting much sleep as I often arrive to work late. I am a lawyer but have not been working much as I have been fighting a huge legal battle over the last few years because my wife passed away following medical negligence. I cannot discuss it any further due to confidentiality. If asked directly, I am vague about the amount of alcohol I drink. If pressed, I admit drinking a bottle of red wine throughout the day and a few beers with my dinner. On the weekends I drink significantly more. I have got angry at my brother who has questioned me about my drinking but I recognise that I may be drinking too much. I have not noticed any changes to my urine or stool nor any other symptoms. If asked about my sexual history in a insensitive manner, I get very mad.
Past Medical History
None
Drug History
None. Allergy to penicillin which causes widespread rash
Family History
Both parents died young in a road traffic accident.
Social History
Non-smoker. Excessive alcohol consumption but only admit if asked directly. No recent travel history. Not sexually active

Introduces yourself
0
1

Confirms name, age & occupation of patient
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1

Explains reason for consultation & builds rapport
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1

Gains consent
0
1

Asks open question
0
1

Establishes duration and trigger (if present)
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1

Establishes evolution (onset to now)
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1

Establishes time course (worsening, continuous, intermittent in Gilbert's syndrome)
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1

Identifies red flags: painless jaundice, weight loss, loss of appetite
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1

Asks for any recent illness, fever or any family members/contacts with similar symptoms
0
1

Asks for gallstone/obstructive symptoms: abdominal pain, pale stool, dark urine, pruritus, steatorrhoea
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1

Asks for liver symptoms: abdominal or ankle swelling, easy bruising, confusion, sleep-night reversal
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1

Asks for associated features: joint pain, lethargy, skin hyperpigmentation
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1

Identifies risk factors for viral hepatitis (intravenous drug user particularly needle sharing, blood transfusions outside the UK, tattoos, piercing, needle stick injuries)
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1

Takes brief sexual history signposting before doing this
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1

Elicits past medical history (specifically asking for previous jaundice, diabetes, haemolytic anaemia, inflammatory bowel disease, heart failure, autoimmune disorders)
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1

Elicits family history (specifically asking for viral hepatitis, autoimmune hepatitis, liver cancer)
0
1

Elicits drug history (specifically hepatitis B and C immunisation, antibiotics, tuberculosis medication, antiepileptics, herbal medication)
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1

Asks for any foreign travel and consumption of raw food
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1

Checks for allergies
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1

Checks if patient smokes
0
1

Takes thorough alcohol history
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1

Asks if any history of illicit drug use
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1

Explores and responds to ideas
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1

Explores and responds to concerns
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1

Explores and responds to expectations
0
1

Shows empathy
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1

Avoids jargon
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1

Summarises back to patient
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1

Thanks patient
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1

Patient global score
0
1
2
Gives reasonable differential diagnosis (Alcoholic liver disease, Pancreatic Cancer, Haemochromatosis, Autoimmune Hepatitis)
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1