UIC Graduation Competency Exam Sample Note
1. History: “Describe the history you just obtained from this patient. Include only
pertinent positives and negatives relevant to this patient’s problem.” (Includes
CC and relevant HPI, PMH, PSH, medications, social history, family history, and
ROS.)
Chief complaint: Blood in stool x 1 week
History of Present Illness:
70 year old female with history of DM, HTN, OA presents with one week of painless,
bright red bloody stools. She was in her usual state of health until one week ago.
She first noticed blood on the toilet paper with bowel movements. Then noticed
blood in toilet bowl over past 5 days, with increased number of bowel movements
for past 3 days. No change in caliber of stool, no melena, no constipation, no
diarrhea, no nausea or vomiting, no tenesmus. No weight change, fevers or chills,
lightheadedness, dizziness, recent travel, and no recent antibiotics H/o normal
colonoscopy 8 years ago. She is concerned that this may be colorectal cancer after
the recent loss of her sister a year ago due to colorectal cancer.
Past Medical History:
DM II x 15 years
Hypertension x 5 years
H/o atypical chest pain followed by negative stress test 5 years ago
Past Surgical History: None
Medications:
Glipizide 5mg daily, Metformin 500mg bid, Diclofenac 75mg daily, Benazapril 5mg
daily, Amlodipine 10 mg daily
Family Medical History:
Mother- deceased age 88, unknown cause
Father: deceased age 72, car accident
Sister 1: Breast cancer, diagnosed at age 70. Doing well
Sister 2: Metastatic colon cancer, age 60. Recently deceased 1 year ago. Pt had
undergone chemotherapy, but had recurrence and spread of disease.
Grandparents: Heart disease, DM II
Social History:
Lives with husband
Retired teacher
No alcohol, no tobacco, no illicit
Has 2 children, 2 grandchildren- ages 7, 16
Review of Systems:
General
No weight loss, fatigue, fevers, chills, night sweats
Decreased sleep x past 5 days. Decreased appetite x 5 days
HEENT
No vision changes. No epistaxis. No hearing changes
Lymph
No swollen glands
CV
No chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnea
H/o heart murmur
Lungs
No shortness of breath, cough
GI
As per HPI.
GU
No urinary frequency, dysuria.
MSK
Bilateral knee and hand pain, early morning stiffness
Skin
No easy bruising, no rashes
NEURO:
No lightheadedness, dizziness.
Psych
+ Increased anxiety over past week
2. Physical Exam: “Describe any pertinent positive or negative findings relevant to
this patient’s problems.”
Vitals
General
HEENT
Neck
CV
Lungs
Abdomen
Rectal
T 98.8 HR 80 RR 16 BP 130/80
Appears anxious, well groomed. No acute distress. Alert, oriented x 3
Pupils equal reactive. No conjunctival pallor.
No cervical or supraclavicular lymphadenopathy
II/VI systolic murmur (Apex)
Clear to auscultation bilaterally
+ Normoactive bowel sounds. Soft, non-distended.
+ Mild LLQ tenderness to deep palpation. No rebound or guarding.
No hemorrhoids. Gross blood, + guaiac
3. DDX: “Based on what you have learned from the history and PE, list up to 3
diagnoses that might explain this patient’s complaints. List your diagnoses from
most to least likely. For some cases, fewer than 3 diagnoses will be appropriate.
Then, enter the positive and negative findings from the history and PE (if
present) that support each diagnosis.”
Diagnosis 1: Diverticulosis
History Findings:
Patient’s age is consistent
Sudden onset.
Painless bleeding
PE Findings:
Mild tenderness in LLQ
Grossly bloody stool
Negative external hemorrhoids
Diagnosis 2: Angiodysplasia
History Findings:
Painless bleeding per rectum
Sudden onset, continuous x 1 week
H/o heart murmur- can often be associated with angiodysplasia
Patient’s age is consistent
PE Findings:
Grossly bloody stool
Negative external hemorrhoids
Diagnosis 3: Colorectal cancer or adenoma
History Findings:
+ Family history (sister)
Blood in stool
Patient’s age is consistent
Last colonoscopy 10 years ago
PE Findings:
Mild tenderness in LLQ
Grossly bloody stool
Negative external hemorrhoids
4. Diagnostic Studies: “List initial diagnostic studies (if any) you would order for
each diagnosis.”
Orthostatics
CBC
Anoscopy
Colonoscopy