Resident Instructions

Open Resident
Instructions

 


 
 
CLINICAL PERFORMANCE EXAMINATION (CPX)

 

Station Length: 15 minutes maximum

Patient Name: Mendoza


Resident Instructions:

The patient is here for follow-up to discuss results of his/her recent colonoscopy.


HPI:

Mr/s. Mendoza has been your patient since internship year. S/he doesn’t come in too often as s/he has been very healthy and has no chronic medical problems. A month ago, Mr/s. Mendoza came to see you for complaints of fatigue and mild RLQ abdominal pain. S/he also complained of occasional dark stools. At that time, physical examination was remarkable only for positive guaiac stool on rectal exam. The remainder of his/her exam was been negative except for a 5 pound weight loss from a prior visit 5 months earlier. You had ordered some labs and found that his/her CBC showed a microcytic anemia. His/her comprehensive metabolic panel was all within normal limits.

You requested a colonoscopy and the patient is returning to discuss the results of this. Unfortunately, a mass in the cecum was identified on colonoscopy, which pathology revealed to be adenocarcinoma. You want to refer the patient to a surgeon and obtain additional x-rays.

At the patient’s last visit, s/he was accompanied by his/her son, Luis. Luis had pulled you aside for a moment while his father/mother went to check out to tell you that his father/mother should not be told any bad news, especially if there is something serious like cancer. He explained that the family wants to protect his father/mother from the shock of any bad news and not make him/her sicker by making him/her afraid.


SOCIAL HISTORY:

Mr/s. Mendoza was born in Mexico and came to the U.S. at 19 years of age with her husband/his wife. S/he is a naturalized US citizen. They lived in Florida. S/he moved to Charlottesville 3 years ago to be closer to his/her son Luis after her husband/his wife died. S/he retired from construction/housekeeping in a public school system when s/he came to Charlottesville. S/he has two children, ages 35 (Luis) and 32 (Anna). Anna lives in Washington, DC. Mr/s. Mendoza has an 8th grade education and can read and write in Spanish. S/he speaks English conversationally and can read and write a little. Mr/s. Mendoza is an observant Catholic and goes to church regularly. S/he has started to make some friends through the church.


INTERVIEW INSTRUCTIONS:

Conduct your interview as per usual, keeping in mind the cultural aspects of disclosing this cancer diagnosis and future steps, taking into account his/ her son’s wishes and the approaches you learned in your preparatory session. After determining the patient’s wishes, you will discuss additional imaging and blood testing and referral to the surgeon.


PHYSICAL EXAM:

Vital signs: BP 120/80, Pulse 84. Resp. 14, Temp 37.2, Weight 75 kg (same as last visit)

 

No additional physical examination is needed today, as the visit is for discussing results and next steps.

 

Once you have obtained a focused history and discussed recommendations with the patient, you are to leave the room and complete a checklist on the computer.

 

 

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