Case e5371

This is a sample eOral case. This sample is intended to show you the types of materials you might encounter during the case and how those materials will appear on the screen. Although laid out in narrative below, cases are seldom this linear, and materials will vary across cases. For a more realistic example of the flow of a case, refer to the video.

Sample Case Summary

This case involves a 22-year-old African-American woman with an acute sickle cell crisis. She has a known history of sickle cell anemia. She presents with right chest pain, right abdominal and flank pain, and bilateral leg pain. The candidate must treat the patient’s pain, address the nursing staff concern, evaluate anemia, order a chest X-ray, and initiate antibiotics.

Candidate Screen

Notes

The examiner has a patient history and physical available to ensure all candidates receive the same information.

This information will be given to you verbally. Be sure to take notes of important information.

Screen for candidate attestation

The case begins with the attestation screen.

This screen asks you to verify three things:

  • Your name and candidate ID, and photo
  • That you have no conflict of interest with the examiner
  • That you agree to abide by your responsibilities under the Policy on Exam Irregularities

screenshot of examiner attestation

All candidates will receive the same set of introductory information.

In this case, there is a video of the patient. You will be able to adjust the volume of the video, and you may ask the examiner to replay the video. Note, however, that replaying them will take time from your case.

The patient’s vital signs are on the right, with the patient’s name just above the blood pressure. The vital signs may change as you manage the patient and an audible alert will be given to let you know the vital signs have changed

examiner view

As you begin to manage the patient, you will see the patient view begin to change.

The human graphic organizer (HuGO) can be accessed throughout the case by clicking on the “Patient View” at the top of the stimuli tray on the left.

In this case, the candidate has asked that an IV (red) with a 250 mL bolus of normal saline (blue) and an antipyretic (blue) be delivered. Devices will appear in red; interventions in blue. Obvious physical findings you would see when entering the room, such as a rash or wound, will be denoted by a yellow triangle. There are no visible features in this case, or they are under the gown, so no triangle is shown.

The most common requests will be illustrated. Since every possible request would make the examiner materials unmanageable, the examiner may verbally affirm that one of your requests has been done. A notepad is provided so you can keep track of your requests that might not appear on the screen. The examiner will also be taking notes on a notepad.

candidate view

candidate view

If you ask for imaging studies, lab reports, or other tests, they will appear in the stimuli tray on the left. Click to access each stimulus.

For new stimuli, the background of each stimulus title will remain green until you open it.

Note the opportunity, at the bottom of the screen, to adjust the size and contrast of the x-ray. You will also be able to adjust the size of the ECG by using the Zoom slide bar. Please note that you may request a paper copy of an ECG from the examiner.

Although not relevant to this case, CT scans and ultrasound exams will appear as videos. There will be a control panel on the lower left of the screen that allows you to pause single CT slices or ultrasound images and replay the video. You may need to hover the mouse over that area to see the control panel.

examiner view

candidate view

candidate view

candidate view

A zoom bar below the stimulus will allow you to enlarge it.

All lab values are given in metric and S.I. units. Unlike the traditional cases, normal values appear on the right. Abnormal lab values are indicated with an asterisk.

examiner view

Sometimes, the examiner may play a video or audio to assist in the play of the case. Many times, these cues will be given verbally by the examiner.

In this case, there is a video cue when the nurse questions the order for a narcotic, believing the patient is drug seeking. Your response to the nurse will be included in your Interpersonal Relations and Communication Skills rating.

Other videos in this case illustrate the patient’s pain level depending on the amount of pain relief you have ordered.

examiner view

candidate view

The vital signs may change as you manage the patient and an audible alert will be given to let you know the vital signs have changed.

You may open a larger view of the rhythm strip by clicking on it. Click on the red “X” in the upper left-hand corner to return to the main screen.

examiner view

candidate view

The examiner has several options for posting vital signs. Not every action by you, however, can be anticipated. In this case, the examiner will deliver the vital signs verbally and the vital signs will be blank.

examiner view