• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a junior doctor

Patient: A 25 year old patient has noticed scrotal swelling

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 25 year old man who has come into A&E.

You have recently been abroad in mykonos for the week, you have just got back yesterday, since then you have been having pain and swelling on the right side of your scrotum. You originally thought was because of the flight but it has not been getting any better overnight. You were having awful night sweats and had to change your sheets twice. You have a headache as well which is noticed when you woke up.

If directly asked you have been having pain on urination for the past 4 days. You have noticed some penile discharge, this is thick yellow.

You are a sexually active gay male, you have not been using protection whilst abroad. You had an STI check before going abroad which was negative for everything. When you went away you had sex (oral, anal both active and passive) with 5 different people.

You have had no trauma.

Your bowel habit is normal.

PMH
No ongoing medical issues

No previous operations

DH

No regular medications

No known drug allergies

SH

You stopped smoking about 4 months ago

You drink about 20 units per week

You live with your partner

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.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / year / grade
Clarifies who they are talking to
Asks patient for preferred name


PC Presenting complaint
Site - unilateral / bilateral
Onset - acute / chronic
Progressively enlarging
Painful or not
Lump always present
Trauma


Sexual health history
Dysuria / penile discharge
Ascertains if currently sexually active
Gender of partners
Use of protection
Oral / anal / vaginal
Previous testing (including hiv)


Associated features
Weight loss
Appetite
Night sweats
Any other similar lumps or lumps
Swelling above the lump


Urology systems review
Polyuria
Suprapubic pain
Urgency
Penile discharge


PMH Past medical history
No past medical history
No previous operations


DH Drug history

No regular medications
No known drug allergies


SH Social History
Alcohol
Smoking
Job
Living situation


ICEF
Explores ideas, concerns, expectations, feelings


Question
Read the following examination findings. Given your history and examination, what is the most likely diagnosis?

Epididymo-orchitis


Question Given your working diagnosis is epididymo-orchitis, what investigations would you like to do?
Bloods = FBC, U&Es, LFTs, CRP
Blood cultures
Urine dip
Urine for MC&S
Gram stained urethral smear
Urethral swab for N. gonorrhoea culture
First pass urine for C. trachoma’s NAAT
Microscopy and culture of mid-steam urine for bacteria


Question What is your general management for this patient?
Antibiotics
Analgesia (including ibuprofen or other NSAID)
Abstain from sexual intercourse whilst treatment is ongoing
Bed rest


Question Given the cause of this patients epididymo-orchitis is probably due to a sexually transmitted pathogen, what antibiotics should be given
Ceftriaxone (500mg IM STAT)
Doxycycline (100mg BD for 14 days)



Score