1. Mrs. Hunter comes to Dr. A.B. Domen’s office for advice at the request of her family practitioner, Dr. Landry. Mrs. Hunter is complaining of stomach pain. Dr. Domen records Mrs. Hunter’s chief complaint, completes an extended system review and a pertinent past family and social history. He also performs a complete single system specialty exam of her stomach and makes a decision of moderate complexity. Dr. Domen prepares a report with his recommendations for Dr. Landry.

2. Dr. Norman visits Jane Pulmones in the hospital a second time to re-evaluate her lung condition. He performs an extensive review of her past medical management, considering at least four possible diagnoses and checks on her progress with an examination of her lungs. During the exam, Dr. Norman looks at the affected body area as well as other symptomatic or related systems and recommends modifications to the attending physician on Ms. Pulmones treatment.

3. Ms. Barb Wire, a new patient of yours, falls of her exercise bike and injures her wrist. Upon presentation in your office, your doctor completes a brief history of the incident with a problem pertinent system review and examines the wrist in an expanded problem focused exam. He orders some x-rays and makes a straightforward decision. He prescribes some Motrin and explains to Ms. Wire his findings.

4. Ms. Sandy Beach has been a patient of yours for the past two weeks. She has been complaining of headaches that have persisted for 6 months. During this particular visit to your office, your doctor, Dr. U. Ken Too, questions Ms. Beach extensively about the history of the headaches, completes an extensive re-examination of her neurological findings and obtains all pertinent past family information concerning headaches, completes a detailed examination of her medical records and tests performed during the visit. After considering all the information he has obtained from the tests, records and Ms. Beach, Dr. Too determines that the diagnoses options are limited, the amount of data reviewed in moderate and the risk of mortality is low.

5. Mr. T. Bone comes to your office to get his sutures removed. He is a regular patient of yours. The sutures were placed by another doctor when Mr. Bone was on vacation. Because the sutures are superficially located on the skin of Mr. Bone’s arm and the healing looks good, the nurse removes the stitches and sends Mr. Bone home.

6. Ms. West is on vacation in your town and was involved in a serious automobile accident. Unconscious, she is rushed by ambulance to the nearest hospital where the emergency department is open. Dr. Quick, noticing the extensive bleeding of the head, asks that Dr. Crane, a neurologist, be summoned and begins the examination. X-rays and tests are ordered. By this time, Ms. West’s male friend has arrived and he is thoroughly questioned concerning the patient’s medical history and a phone call is placed to her family physician for more detailed information. Drs. Quick and Crane review all the medical information, x-rays and test data. Ms. West is till unconscious and in critical condition, tests show possible brain damage, a skull fracture and internal bleeding. One and one-half hours later Ms. West is moved to the intensive care unit for continued observation. Code for Dr. Quick.

7. Ms. Chip A. Dee presents her son (a new patient) to your office one afternoon after school. The 12-year-old boy is complaining of feeling dizzy and having a sore throat. As your doctor begins her exam, she notices some sever bruising on young Chip’s body. Your physician does an extended history on Chip’s illness, with a complete system review and asks some serious questions of Chip’s mom. Upon completing this comprehensive history your physician performs a complete multi-system examination checking for any broken bones as well as a thorough exam of Chip’s throat. Your physician reviews a multiple number of diagnoses, and decides that the risk of complications or even death to young Chip is high. She leaves the room and reports Mr. and Mrs. Dee to Children’s Protective Services.

8. Ms. I Keri Nuff, a 95 year old patient, presents herself in your office for the first time complaining of general malaise. Upon completion of a comprehensive history and a comprehensive exam, you decide that there are several diagnoses that may apply to Ms. Nuff’s case, and because of her age, her risk of complications is moderate. You decide that Ms. Nuff should be admitted to the hospital for further tests. You admit Ms. Nuff on that same day.

9. Mr. U. Never Doalot, an established patient of yours for years, comes into your office complaining of back pain. Mr. Doalot is a 32-year-old unemployed patient. You examine Mr. Doalot’s back briefly and find out how long he has had this pain. Mr. Doalot says that he helped his brother- in-law move yester and it was last night that his pain began. You explain to Mr. Doalot that he should take some aspirin and begin to show him some exercises that should help alleviate his pain. Mr. Doalot has difficulty understanding you diagnosis and treatment plan and you spend the next 40 minutes explaining his therapy.

10. An 85 year old patient of yours in admitted to the hospital by an orthopedist to test for possible bone cancer. As the internist for the patient you are asked to treat her for diabetes. During your initial visit to see the patient, you complete a problem focused history and exam, making a straight forward decision to continue the patient’s treatment as it is.