Location: You are a junior doctor in general practice
Patient: A 55 year old patient has noticed scrotal swelling
– 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 55 year old man who has come to see you GP because your testicle is getting bigger.
The testicle is not painful or uncomfortable. You thought maybe testicles got bigger later on in life. You originally thought it would go away because it has not been painful but it seems to be slightly larger than it was before. Over the past week there has been a dull ache which you have been taking paracetamol for but it does not seem to of helped.
You have lost weight but you think you could lose a few pounds, so you have been trying to eat more healthy.
You have had no trauma.
No lower urinary tract symptoms = frequency, dysuria, ect
Your bowel habit is normal.
You are sexually active. Same partner for the past 15 years. You recently have had an STI test a month ago that was negative.
PMH No ongoing medical issues
No previous operations
No history of testicular censer, trauma or infection.
You do not take any regular medications
No known drug allergies
You stopped smoking about 4 months ago
You drink about 20 pints of beer a week
You live with your partner
You originally thought it would go away because it has not been painful but it seems to be slightly larger than it was before. You are worried this could be cancer. You need to ask the doctor if they think it is cancer or not? You keep asking until you get an answer as you need to know.
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.