Testicular tumour


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in general practice

Patient: 25 year old patient has noticed a 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 usually fit and well 25 year old man. Your partner noticed a lump down below about 3 months ago, you have agreed to come in because they keep asking you to make an appointment. 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 are not sure if you have lost weight but you have noticed you have had to do up your belt tighter than you usually do.

You have had no trauma.

No lower urinary tract symptoms = frequency, dysuria, ect

Your bowel habit is normal.

You are sexually active. Sex with men, same partner for the past 3 years. You recently have had an STI test 3 weeks ago that was negative.

PMH
No ongoing medical issues

You had to have an operation when you were younger because your testicles did not descend correctly but you were to young to remember the details of this.

DH

You do not take any regular medications

No known drug allergies

SH

You stopped smoking about 4 months ago, you now use a vaper

You drink about 10 pints of beer a week

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 lumps
Swelling above the lump


Urology systems review
Dysuria
Polyuria
Suprapubic pain
Urgency
Penile discharge


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
Previous orchidopexy


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
Explores ideas, concerns, expectations, feelings
Candidate directly states this could be cancer / does not give false hope e.g just to be safe it is not cancer


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

Testicular tumour


Question Given you are in GP, what is your management
Referral to urologist under the 2 week rule


Question What investigation should be urgently done by urology?
Testicular ultrasound


Question What is the biggest risk factor for developing testicular cancer?
Undescended / maldescended testes


Question Which lymph nodes do the testes drain into?
Para-aortic lymph nodes



Score