Mock 10

Clinical Scenario for Role Play: Assessing a Teenager with a Headache after Excessive Alcohol Use

Background Information:

• You are an FY2 doctor in the Emergency Department.
• Mark / Amanda, aged 17, has come to the department complaining of a headache.
• She reports having drunk alcohol excessively over the last few days.

Patient Profile:

• Male / Female, 17 years old.
• Presenting complaint: headache.
• Recent history of excessive alcohol consumption.

Scenario Setup:

• Mark / Amanda appears distressed by the headache, which she describes as severe. You need to conduct a thorough assessment to determine the cause and appropriate treatment.

Patient Prompts:

1. Description of the Headache:

   • Mark / Amanda might say, "My head has been killing me since I woke up, and it's not getting any better. I drank a lot this past weekend."

2. Seeking Relief:

   • She / He might ask, "Can I get something for the pain? It’s really bad."

Clinchers:

• Detailed History Taking:
  • "Can you describe the headache? Where does it hurt? Did anything seem to trigger it besides the alcohol? How long have you had it?"

Important Points to Keep in Mind:

• Assessment of Headache:

  • Evaluate the characteristics of the headache (e.g., location, quality, duration, associated symptoms like photophobia or nausea).
  • Assess for red flags that could indicate a more serious condition, such as meningitis or intracranial hemorrhage (e.g., neck stiffness, fever, vomiting, visual disturbances, confusion, or a headache that worsens with position changes).

• Evaluation of Alcohol Use:

  • Discuss the amount and type of alcohol consumed and the frequency of her drinking episodes. This can help in assessing whether her current symptoms might be related to alcohol withdrawal, intoxication, or dehydration.

• Physical Examination:

  • Perform a general physical examination, including vital signs (looking for signs of fever, hypertension, or other abnormalities).
  • Conduct a neurological examination to check for any focal neurological deficits, signs of increased intracranial pressure, or signs of infection.

• Management and Advice:

  • Depending on your findings, management might include rehydration, pain relief with caution (avoiding medications that could cause further harm given her recent alcohol use), and possibly antiemetics if nausea is present.
  • If any red flags or concerning symptoms are identified, further investigations (such as a CT scan) and treatments will need to be considered.

Expected from the Doctor:

• Professionalism and Empathy:

  • Display empathy and concern for Amanda’s wellbeing, addressing her pain and discomfort while also taking her age and the implications of her alcohol use into account.

• Clear Communication and Education:

  • Communicate your findings and plan clearly to Amanda, ensuring she understands the potential causes of her headache and the importance of not consuming alcohol, especially given her age.
  • Educate her about the risks associated with underage drinking and excessive alcohol consumption.

• Safety and Follow-Up:

  • Ensure Mark / Amanda has a safe plan for getting home from the hospital, especially if she’s been drinking recently.
  • Recommend follow-up either with the GP or an appropriate service to address her alcohol consumption if it’s identified as problematic.

This scenario tests your ability to handle potentially complex cases involving young patients with risky behaviors, requiring both medical acumen and a sensitive approach to adolescent health issues.