Name
Victoria Bennett
DOB
28/08/1984 (31 years)
Occupation
Gardener
History
I have noticed that I have become increasingly yellow over the last few days. I am quite worried I may have cancer because I can't think of any other reason my skin could have changed colour. Over the last year I have had increasing fatigue, mild itchiness and I have lost my appetite. I have not noticed any changes to my urine or stool nor noticed any other symptoms
Past Medical History
Graves disease since the age of 20
Drug History
Carbimazole. No known allergies
Family History
Father has psoriasis
Social History
Non-smoker. Do not drink alcohol. Recent travel to Ireland. Sexually active with long term male partner, no other sexual partners

Introduces yourself
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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
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1

Asks open question
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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
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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

If female asks if pregnant (HELLP, obstetric cholestasis)
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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)
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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 or drinks
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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
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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
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1
2
Gives reasonable differential diagnosis (Autoimmune Hepatitis, Hepatitis B, Pancreatic Cancer)
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1