EXAMINER’S MARKING SHEET

STATION NO. 17 – PANIC ATTACK SCHOOL

STUDENT’S NAME EXAMINER’S NAME

INSTRUCTIONS TO STUDENT:
This is an 11 MINUTE station.
You are a Trainee Intern attached to a city general practice and have been asked to conduct the initial assessment on Ms X,
who has been troubled by two recent “attacks”, as she will describe. Please take a history, which covers medical and
psychiatric conditions, and develop a list of diagnoses which need to be considered. You will be stopped at 10 minutes and
asked what the clinical term for these attacks is, and the likely differential diagnoses.
TASK Score
1

/2

/2
Panic attack: /1
Asks about the following symptoms - /6
/1
2 Other medical/lifestyle:
Enquires about -
 Cardiovascular (any question about the heart) /0.5
 Thyroid (eg lost weight, heat intolerance) /0.5
 Seizure (eg lost consciousness, history of epilepsy) /0.5
 Substance misuse (asks about substance use ) /2
 Excessive caffeine intake (asks about amount) /2
 Other reasonable areas to consider (others 0.5 pts each to total of 1.5 - /1.5
eg family history, patient’s view of cause) /7
3 At 10 minutes stop, ask for the clinical term and list the likely differential diagnoses:
(Correct answer) PANIC ATTACKS (not panic disorder)
/1
Appropriate differential diagnoses discussed in a sensible manner -
[1] for any reasonable psychiatric disorders
[1] for any reasonable physical conditions listed above (phaeochromocytoma added)
/2 /3
Subtotal /16

COMMUNICATION CRITERIA: History Taking Station (4 marks in total)

Examiner Rated (2 marks) All the time Occasionally Never
a) The student put the patient at ease and communicated clearly.
1 0.5 0
The student used open-ended questions and allowed the patient to
b) explain the symptoms. 1 0.5 0
/2
Examiner to ask the PATIENT (2 marks) Very Moderately Not at all
c) How well did you understand the student?
1 0.5 0
d) How likely would you be to come back and discuss your
1 0.5 0
concerns with this student again? /2
TOTAL /4

NOTES FOR EXAMINER (Circle the appropriate number)

1. At 5 minutes the student should finish their sentence and leave. Below the expected level 1
2. At 6 minutes the next student should be ready to begin.
3. Examiners should mark independently of their co-examiner. Borderline 2
4. The total mark from 16 points and 4 points will determine the student’s score. At the expected level 3
5. Independently of that, please rate the student’s overall performance at this station
compared with a beginning trainee intern. Above the expected level 4
 Station No. 17
Instructions for Student

This is an 11 Minute station.

You are a Trainee Intern attached to a city

general practice and have been asked to
conduct the initial assessment on Ms X, who
has been troubled by two recent ‘attacks’,
as she will describe.

Please take a history, which covers medical

and psychiatric conditions, and develop a
list of diagnoses that need to be considered.

You will be stopped at 10 minutes and

asked:

 what the clinical term for these attacks is,

and
 the most likely differential diagnoses.
 STATION NO. 17
INSTRUCTIONS FOR SIMULATED PATIENT

(31 year old Female)

The student will be given marks for the way that s/he establishes rapport with you as
well as for the “medical content” of the answers.

If the student asks you a closed-ended question, then you should reply to that question
only. If the student asks you an open-ended question, you should feel free to expand on
the answer you give.

Do your best to put yourself in the actual role of the patient and respond as you might
in that situation. If you feel uncomfortable, for example, you would offer less
information.

You are a 31 year old married real estate agent, with no children.

Over the last two months, you have twice experienced very distressing episodes of
palpitations, difficulty with breathing and a sense of being smothered, feeling nauseated and
light-headed. They each lasted approximately 20 minutes and passed off without your doing
anything. The first one occurred when you were still watching TV one Wednesday evening
alone (your husband was out late at a work meeting at the time). The second took place two
days ago while you were shopping in the supermarket. You abandoned your shopping
trolley, rushed out to the car and phoned your husband on the cell phone to get him to come
to help you. In both cases, you felt sure that you were going to die. You are sure that this
means your heart is at fault; your father died suddenly at the age of 58 of a myocardial
infarction (he was overweight and smoked 10-12 a day).

Your relationship with your husband has become strained over the last year as you very
much want to start a pregnancy soon but he does not want any children. Your job can at
times be stressful but you enjoy it. You probably don’t exercise adequately, your hobbies
tend to be sedentary, reading, film, theatre, jazz.

On average, you have 3-4 cups of coffee a day, usually with friends from work.
Your physical health has been good up till now. You think of your childhood as a happy
secure one; you are the younger of two daughters and regard yourself as close to your mother
and sister.

You consider that your personality is a happy one, perhaps a little fussy or fastidious about
keeping things in order. You certainly do not have any compulsions or ritualistic behaviours.
 STATION No. 17

QUESTIONS WHICH EXAMINER WILL ASK

PATIENT

(1) How well did you understand the student?

Very (1) Moderately (0.5) Not at all (Nil)

(2) How likely would you be to come back and

discuss your concerns with this student
again?

Very (1) Moderately (0.5) Not at all (Nil)