• Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are a junior doctor in general practice

Patient: A 55 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 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.

DH

You do not take any regular medications

No known drug allergies

SH

You stopped smoking about 4 months ago

You drink about 20 pints of beer a week

You live with your partner

ICEF

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.

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


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


Urology systems review
Dysuria
Polyuria
Suprapubic pain
Urgency
Penile discharge


Systems review Systems review
General = fever, rigors, night sweats, weight loss
Cardiorespiratory = chest pain, palpitations, SOB, sputum, leg swelling
Gastrointestinal = dysphagia, N&V, indigestion / reflux, abdominal pain, change in bowel habit


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


FH Family history
Family history appropriately asked about


ICEF ICEF
Explores ideas, concerns, expectations, feelings
Candidate directly states if they think this could be cancer or not


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

Hydrocele


Question Given you are in GP, what is your management
Reassure unlikely cancer
Routine referral to urology


Question What is a hydrocele?
Fluid within the tunica vaginalis


Question What are the management options of hydroceles?
Watch and wait
Fluid aspiration
Surgery



Score