Practice medicine on apatient who talks back.
Interview, investigate, and commit to a diagnosis. Scored on your reasoning, like the ward will.
01 · History
Every question changes the answer.
Ask what you would actually ask. The patient answers in their own words, and the story shifts.
Encounter · Turn 3 of 10
02 · Workup
Real investigations. No answer choices.
Order from 245 tests and 132 exam manoeuvres. Results return as data you must read yourself.
Lab report · Bloods
58 M · Chest pain
03 · Pressure
Time matters here.
Hesitate and your patient gets worse. The monitor tells you before anyone else does.
Room 3 · Emergency
Chest pain · 58 M
HR
74
bpm
BP
118/76
mmHg
SpO₂
99
%
RR
15
/min
04 · Debrief
Scored on reasoning, not recall.
Commit to a call and defend it. The debrief shows what you caught, what you missed, and why.
Final diagnosis · Declared
Acute anterior STEMI
CS-047BF1 · The Open Whistle
Yours ST-Elevation Myocardial Infarction
Answer Acute Anterior STEMI
Raghav Malhotra · 58y M · 10 turns · 5 labs · 2 exams
Review Snapshot
The fastest read on what mattered most, and what most clearly went wrong.
Key clue
In acute chest pain with ST elevation on ECG, immediate reperfusion therapy is paramount and should not be delayed by further investigations.
Biggest miss
Continuous cardiac monitoring was not explicitly mentioned as ordered or performed in the encounter evidence.
Clinical Review
Start here: what helped you, then what pulled the case off course.
13 strengths · 5 to sharpen
What you got right
13[diagnosis] Identified acute coronary occlusion as the primary diagnosis
Final diagnosis was ST-Elevation Myocardial Infarction — a form of acute coronary occlusion.
[investigation] Obtained and correctly interpreted the ECG rapidly
Ordered the ECG early; the result identified ST elevation in the anterior leads indicating acute transmural injury.
[management] Gave aspirin immediately
Administered Aspirin 300 mg PO during the encounter.
What you missed
5Steps that would have strengthened the encounter.
[monitoring] Place the patient on continuous cardiac monitoring
Not explicitly ordered or performed in the encounter evidence.
[management] Activate the primary PCI pathway by name
Reperfusion was escalated, but the primary PCI pathway wasn't explicitly named.
Score breakdown
13/18 metCS-047BF1 · The Open Whistle
Yours ST-Elevation Myocardial Infarction
Answer Acute Anterior STEMI
Raghav Malhotra · 58y M · 10 turns · 5 labs · 2 exams
Review Snapshot
The fastest read on what mattered most, and what most clearly went wrong.
Key clue
In acute chest pain with ST elevation on ECG, immediate reperfusion therapy is paramount and should not be delayed by further investigations.
Biggest miss
Continuous cardiac monitoring was not explicitly mentioned as ordered or performed in the encounter evidence.
Clinical Review
Start here: what helped you, then what pulled the case off course.
13 strengths · 5 to sharpen
What you got right
13[diagnosis] Identified acute coronary occlusion as the primary diagnosis
Final diagnosis was ST-Elevation Myocardial Infarction — a form of acute coronary occlusion.
[investigation] Obtained and correctly interpreted the ECG rapidly
Ordered the ECG early; the result identified ST elevation in the anterior leads indicating acute transmural injury.
[management] Gave aspirin immediately
Administered Aspirin 300 mg PO during the encounter.
What you missed
5Steps that would have strengthened the encounter.
[monitoring] Place the patient on continuous cardiac monitoring
Not explicitly ordered or performed in the encounter evidence.
[management] Activate the primary PCI pathway by name
Reperfusion was escalated, but the primary PCI pathway wasn't explicitly named.
[haemodynamics] Assess for cardiogenic shock (Killip class)
BP 92/58 in an anterior STEMI raises concern for pump failure — a shock / Killip assessment wasn't documented.
Clinical Handoff Review
Disposition & management review
Your disposition
Cath lab → CCU
Expected
Cath lab → CCU
Disposition matched the case needs
Correct — primary PCI in the cath lab, then CCU, is the right pathway for an anterior STEMI.
Management plan
3 matched4 missedWhat was missing
Score breakdown
13/18 metWorkup checklist: 4/6 steps completed
Normalised from 13/18 rubric items met.