The Most Common FSP Cases: The Classic Presentations You Need to Prepare For

The question I hear most often while preparing for the FSP is: "Which cases come up?" The answer is actually reassuring: the presentations you'll meet in the exam are largely well-defined and recurring classics. Picture a typical patient walking into the emergency department — the FSP asks about exactly those. In this article I've gathered the most common cases, and for each one the leitsymptom (leading symptom), the key history questions you need to ask, and the differential diagnosis (Differentialdiagnose / DDx) clues you must not miss.

1. The logic of FSP cases: systematic, not memorised

The FSP is not a medical exam, it's a medical German exam — but if you can't build the case with clinical reasoning, language won't save you either. The chain that works in the exam is always the same:

Leitsymptom → Differential diagnosis (DDx) → Diagnostic plan. That is: catch the patient's leading symptom → run 3–5 possible diagnoses that fit it through your mind → ask the questions and order the tests that will rule each one in or out.

Instead of memorising disease after disease, learn to think through the leitsymptom. Because the patient won't tell you "I have pneumonia"; they'll say "I'm coughing and I've got a fever." Your job is to open up the possibilities behind that cough. The same symptom (e.g. chest pain) can point to a heart attack, a pulmonary embolism, or simple muscle pain — what sets you apart is being able to narrow down to the right diagnosis with the right question.

2. The most common cases — leitsymptom, key history and DDx

The table below summarises the presentations you'll meet most often, both in the FSP and in everyday emergency practice. Think of each row as a "reflex package": see the symptom, ask the key question, run the DDx through your mind.

3. Red flags for the major leitsymptoms

Every symptom has its "danger signs." Asking about these specifically in the history both saves lives and shows the examiner your clinical maturity:

• Brustschmerz (chest pain): radiation to the left arm/jaw, cold sweat, pain that won't ease at rest, tearing back pain (Dissektion).
• Kopfschmerz (headache): "the worst headache of my life", sudden onset (Donnerschlag / thunderclap), neck stiffness + fever, neurological deficit, pain worse in the morning with vomiting.
• Bauchschmerz (abdominal pain): board-like rigid abdomen (Abwehrspannung), unstoppable vomiting, bloody stool/vomit, collapse + pale patient.
• Dyspnoe (shortness of breath): blue lips (Zyanose), too breathless to speak, accompanying chest pain, unilateral leg swelling (suspected PE).
• Rückenschmerz (back pain): urinary/faecal incontinence, saddle anaesthesia (cauda equina syndrome), fever, night pain + weight loss (malignancy/infection).

4. The core you must ask in every case

Whatever case comes up, there's an unchanging history skeleton. If there's pain, OPQRST, then the vegetative review, then medication/allergy/habits. Once you've made this a reflex, you'll never be left stranded even with a case you've never seen:

• OPQRST: Onset, Provocation (triggering/relieving), Quality (character), Radiation, Severity (1–10), Time (duration/timing).
• Vegetative: fever, appetite, weight change, stool/urine, sleep, night sweats.
• Medication & allergy: "Nehmen Sie regelmäßig Medikamente? Haben Sie Allergien?"
• Habits & family: smoking (pack-years), alcohol, family history, past illness/surgery.

I've collected the ready-made German phrasing for this core, one by one, in a separate guide: FSP History-Taking Phrases →

5. How should you present the DDx in the Vorstellung?

Building the differential in your head isn't enough; in the third part (Arzt-Arzt-Gespräch / Vorstellung) you have to present it clearly to your colleague. A good DDx presentation has this structure:

"Meine Verdachtsdiagnose ist … (the most likely diagnosis), weil … (supporting findings). Differentialdiagnostisch kommen … in Betracht (list the DDx). Zum Ausschluss würde ich … veranlassen (the tests you'd order)."

So, in order: (1) state your most likely diagnosis with its rationale, (2) list 2–3 important differential diagnoses, starting with the most dangerous, (3) specify the plan to rule each one out (blood work, ECG, imaging). The "rule out the life-threatening diagnosis first" logic (e.g. in chest pain, ACS and Lungenembolie first) is both good medicine and a high score.

6. Preparation strategy: work system by system

If you study the cases not at random but organ system by organ system, your brain remembers them in clusters. The order I recommend:

• Cardiovascular: ACS, hypertensive crisis, Lungenembolie, syncope, Herzinsuffizienz.
• Respiratory: Pneumonie, COPD-Exazerbation, asthma, Pneumothorax.
• Gastrointestinal: Appendizitis, Cholezystitis, Pankreatitis, Gastroenteritis, ulcer.
• Neurological: Schlaganfall, Migräne, seizure, headache DDx.
• Urinary/other: Nierenkolik, Pyelonephritis, diabetes/Hypoglykämie.

For each system: simulate 3 classic cases from start to finish (history → DDx → plan → Vorstellung). Work cases with the same leitsymptom side by side so the distinguishing questions become automatic. Rather than reading one case 10 times, actively simulating 10 different cases once is far more durable.

⚕️ This content is for general information and exam preparation; it is not clinical advice or a treatment recommendation. In real patient care, rely on current guidelines and specialist assessment.