I-HUMAN CASE [Publish Date]
I-Human Case: 57 years old ,reason for encounter high
blood pressure Anselmo Lopez
, I-HUMAN CASE [Publish Date]
Patient Name Anselmo Lopez
Age / Gender 57 years / Male
Ethnicity Hispanic (Mexican-American)
"My blood pressure is high" / "The nurse at the fair sent me here"
Reason for Encounter (Chief
Complaint)
Setting Outpatient primary care clinic
Duration ~45-minute simulated encounter
Difficulty Level Intermediate
Learning Objectives
Hypertension diagnosis, cardiovascular risk assessment, lifestyle counselin
medication management
SECTION 1: PATIENT INTRODUCTION & CHIEF COMPLAINT Opening Scene / Triage Note
Patient Arrival: Anselmo Lopez walks into the exam room slowly, appearing tired but in no acute
distress. He is carrying a small paper bag with medication bottles and a handwritten note from a
community health fair. He sits down heavily in the chair.
Initial Greeting (Scripted):
Provider: "Good morning, Mr. Lopez. I understand you're here because of your blood pressure?"
Patient (Anselmo): "Yeah, doc. My wife, she's been on me for months. I went to that health fair
at the church last Saturday. The lady there took my pressure and said, 'Sir, you need to go to a
doctor right away.' I feel fine, but here I am."
SECTION 2: HISTORY OF PRESENT ILLNESS (HPI) Interview Questions and Expected Student Responses
Below is the full list of required HPI questions the student must ask, with Anselmo's simulated responses
and the clinical significance of each answer.
# Question Patient Response Clinical Significance
, I-HUMAN CASE [Publish Date]
Indicates Stage 2
"What was your hypertension (≥160/100).
blood pressure White coat effect possible
reading at the "She said 170 over 92. But I was but unlikely to account for
1 health fair?" nervous. I don't like doctors." full elevation.
# Question Patient Response Clinical Significance
Suggests undiagnosed
"Have you ever "Not really. I mean, maybe once
chronic hypertension. Lack
been told you have or twice years ago, but nobody
2 of prior treatment is a risk
high blood pressure put me on medicine. I don't go
factor for target organ
before?" to doctors much."
damage.
"Maybe 5 years? No, 6. My
Indicates poor health
"When did you last see wife made me go for a
maintenance. No recent
3 a primary care physical. They said my
labs or preventive
provider?" cholesterol was a little high
screenings.
but I didn't take anything."
"Yeah, in the mornings
Morning occipital
sometimes. Back of my head.
headache is classic for
"Do you have any It's dull, not sharp. Goes away
4 hypertension (increased
headaches?" after I've been up a couple
intracranial pressure
hours. I take Tylenol maybe
during sleep).
once a week."
"No, nothing like that. I get
"Do you have any heartburn, but that's different. Denies angina.
5 chest pain, pressure, It's right here (points to Differentiates GERD from
or tightness?" epigastrium). cardiac chest pain.
Especially after tacos or chili."
"Well, I'm 57. I get winded
"Do you have Mild dyspnea on exertion.
climbing stairs. But I can still work.
6 shortness of breath Possible early heart failure
I lay flooring, so I'm on
with activity?" or deconditioning.
my knees all day."
"Do you ever feel
your heart racing, Denies palpitations. Low
7 "No. My heart feels normal."
fluttering, or skipping suspicion for arrhythmia.
beats?"
I-Human Case: 57 years old ,reason for encounter high
blood pressure Anselmo Lopez
, I-HUMAN CASE [Publish Date]
Patient Name Anselmo Lopez
Age / Gender 57 years / Male
Ethnicity Hispanic (Mexican-American)
"My blood pressure is high" / "The nurse at the fair sent me here"
Reason for Encounter (Chief
Complaint)
Setting Outpatient primary care clinic
Duration ~45-minute simulated encounter
Difficulty Level Intermediate
Learning Objectives
Hypertension diagnosis, cardiovascular risk assessment, lifestyle counselin
medication management
SECTION 1: PATIENT INTRODUCTION & CHIEF COMPLAINT Opening Scene / Triage Note
Patient Arrival: Anselmo Lopez walks into the exam room slowly, appearing tired but in no acute
distress. He is carrying a small paper bag with medication bottles and a handwritten note from a
community health fair. He sits down heavily in the chair.
Initial Greeting (Scripted):
Provider: "Good morning, Mr. Lopez. I understand you're here because of your blood pressure?"
Patient (Anselmo): "Yeah, doc. My wife, she's been on me for months. I went to that health fair
at the church last Saturday. The lady there took my pressure and said, 'Sir, you need to go to a
doctor right away.' I feel fine, but here I am."
SECTION 2: HISTORY OF PRESENT ILLNESS (HPI) Interview Questions and Expected Student Responses
Below is the full list of required HPI questions the student must ask, with Anselmo's simulated responses
and the clinical significance of each answer.
# Question Patient Response Clinical Significance
, I-HUMAN CASE [Publish Date]
Indicates Stage 2
"What was your hypertension (≥160/100).
blood pressure White coat effect possible
reading at the "She said 170 over 92. But I was but unlikely to account for
1 health fair?" nervous. I don't like doctors." full elevation.
# Question Patient Response Clinical Significance
Suggests undiagnosed
"Have you ever "Not really. I mean, maybe once
chronic hypertension. Lack
been told you have or twice years ago, but nobody
2 of prior treatment is a risk
high blood pressure put me on medicine. I don't go
factor for target organ
before?" to doctors much."
damage.
"Maybe 5 years? No, 6. My
Indicates poor health
"When did you last see wife made me go for a
maintenance. No recent
3 a primary care physical. They said my
labs or preventive
provider?" cholesterol was a little high
screenings.
but I didn't take anything."
"Yeah, in the mornings
Morning occipital
sometimes. Back of my head.
headache is classic for
"Do you have any It's dull, not sharp. Goes away
4 hypertension (increased
headaches?" after I've been up a couple
intracranial pressure
hours. I take Tylenol maybe
during sleep).
once a week."
"No, nothing like that. I get
"Do you have any heartburn, but that's different. Denies angina.
5 chest pain, pressure, It's right here (points to Differentiates GERD from
or tightness?" epigastrium). cardiac chest pain.
Especially after tacos or chili."
"Well, I'm 57. I get winded
"Do you have Mild dyspnea on exertion.
climbing stairs. But I can still work.
6 shortness of breath Possible early heart failure
I lay flooring, so I'm on
with activity?" or deconditioning.
my knees all day."
"Do you ever feel
your heart racing, Denies palpitations. Low
7 "No. My heart feels normal."
fluttering, or skipping suspicion for arrhythmia.
beats?"
