Simulation Page

Scenario 1: "Classic MI – Reflux Distraction"

HPI: Mrs. Johnson presents with chest heaviness for 30 minutes, radiating to her jaw. She is mildly diaphoretic, describes "bad reflux" after chili last night. No meds tried at home. She appears anxious about being at the hospital.
Initial Approach (Choose any):
What is your reasoning? What diagnoses do you suspect? Could you fall for confirmation bias?
Results (appear as actions are taken in real life):
  • Vitals: HR 88, BP 144/89, RR 18, SpO₂ 97% RA
  • EKG (returns in 3 min): Sinus rhythm, subtle T inversions V2-4
  • PMH: T2DM, Hypertension, GERD (no prior MI/surgeries)
  • Exam: Diaphoretic, mild distress. No murmurs/rales. No reproducible pain.
If "Physical exam" not done, you miss lack of tenderness.
Orders & Next Tests: Repeat EKG every 15 min Cardiology consult Chest X-ray Serial troponins
Next Steps:
Reflect: What led to your decision? Where could bias mislead you?
Mentor Insight: A subtle MI caught early here saves a life—anchoring on reflux in an at-risk diabetic woman risks a delayed or missed diagnosis. Always consider ACS, especially with risk factors and non-reproducible pain.

Scenario 2: "Atypical – Fatigue & GI focus"

HPI: Two weeks after the last visit, Ms. Johnson returns. She complains of vague upper abdominal pain and fatigue, says “it’s just my diabetes acting up”, denies chest pain or GI symptoms. All initial VS are normal.
First Steps (Choose):
Write your rationale. Are you at risk for premature closure?
Results:
  • Vitals: All normal
  • If broad ROS: admits “it did go up to my neck for a moment.”
  • PE: Unremarkable
  • Labs pending (delay for effect)
Disposition Choices:
Mentor Tip: Many diabetics and especially Black women present atypically with ACS—don’t let subtle complaints distract from high-acuity disease.

Scenario 3: "Musculoskeletal Trap"

HPI: After moving furniture, Mrs. Johnson has sharp left chest pain worse with movement, no SOB. Exam reveals tenderness at left costochondral junction, VS normal.
First Steps (Choose):
How confident are you this is musculoskeletal? Could you miss anything dangerous?
Results:
  • Vitals: All normal
  • Tenderness to palpation at costochondral margin only
  • If no broad ROS/PE: no cardiac red flags sought
When in doubt, consider broad systemic causes before closing on MSK—especially in high-risk patients.
Mentor Story: There have been missed cardiac events disguised as “chest wall pain.” Always probe for atypical symptoms in high-risk patient populations.
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