Location: Foundation doctor in general practice
Patient: Mrs Summer, a 55 year old, has come into clinic after noticing a lump in her left breast
Task: – Take a focused history from the patient – After 6 minutes you will be asked a series of questions by the examiner. – Answer any questions that the patient may have
Note to actor:Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.
You are a 45 year old patient who feels silly about coming into see the GP today. You’re really only here to put your partner’s mind at rest. You’ve noticed a lump in your left breast, it’s been there for about 3 months.
If asked, you think it’s been increasing in size, the shape doesn’t feel smooth and the skin over the top feels different but you are not sure how to describe this. Size is roughly that of a grape. Position is above the nipple. Firm in consistency.
You have not lost any weight that you know of.
If asked you started periods when you were 11 years old and your periods stopped when you were 50.
PMH – none
DH – no regular medications, no known drug allergies
SH – you smoke 30 cigarettes a day, drink a glass of wine at the weekend
FH – mother died of breast cancer aged 65
ICE – you think you are getting older and your breast are changing, you are concerned that this is happening on one side only.
If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.