• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a foundation doctor in general practice

Patient: 69 year old retired builder, who presents with a dull dragging discomfort in his right groin

Task:

  • Take a focused history from the patient
  • At 4 minuets you will be presented with an image and asked to explain how you would examine, identifying any features in the photo
  • After 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 to 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 69 year old man who presents to general practice with a 3 week history of a dull dragging discomfort in your right groin which is worse throughout the day.

If directly asked there is a swelling which is worse on standing but resolves when laying flat.

PMH

  • Hypertension
  • High cholesterol
  • No previous surgery

DH

  • Amlodipine
  • Atorvastatin
  • KNDA

SH

  • Smokes 15 per day
  • Drinks 3 pints each weekday and about 10 pints on both Saturday and Sunday

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are talking to
Asks patient for preferred name


HPC Groin Pain - SOCRATES
Site – where is the lump
Onset – when first noticed?
Characteristic – is the lump always there or does it come and go
Radiation
Timing
Exacerbating and relieving factors
Severity


Causes Hernia causes
Chronic cough
Straining / Constipation
Obesity
Heavy lifting
Previous groin surgery


Complications Complications
Ever get stuck / unable to reduce swelling?
Colicky abdominal pain
Nausea and vomiting
Absolute constipation
Does it ever get red, tender, very painful, hot?


Alternative diagnosis Alternative diagnosis
Trauma
Infection of lower limb or groin
Fever, weight loss, night sweats


PMH Past Medical History
Hypertension
High cholesterol
No past operations


DH Drug History
Amlodipine
Atorvastatin
KNDA


SH + FH Social & Family History
Socially and family history appropriately asked about


ICE ICE
Explores ideas, concerns, expectations
Asks patient if they have any questions


Examination
Please review the following photo, identify the abnormality and explain how you would examine this patient

Candidate identifies left groin swelling on inspection
Gets patient cough and observes for change


Examination Palpation
Palpates swelling for size, shape, pain, temperature
Gets patient to cough and feels for impulse
Establish nature of hernia (inguinal / femoral) - relation to pubic tubercle
Assesses if reducible or not: ask patient to reduce first
Places fingers over deep ring and asks patient to cough.


Question On examination, the hernia is superior and medial to pubic tubercle and doesn't recur when your fingers are held over the deep ring and the patient coughs. What is your most likely diagnosis based on your history and examination findings?
Indirect inguinal hernia


Question Where is the deep inguinal ring found anatomically?
Midpoint of the inguinal ligament
Inguinal ligament = ASIS to pubic tubercle



Score