Testicular lump Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
N.B. Because the focus of this session is split between taking a very focussed history and examining the patient, a lot of the questions you would ask in the PMH/FH/SH can be asked here
Enquires about nature and duration of the problem:
Asks about change in lump over time - “has there been any change in the lump since when you first noticed it?”
Asks how frequently self-examines normally - “how often do you examine your testicles?”
Specifically asks about pain - “do you have any pain in your testicles?”
Urinary symptoms - “have you had any difficulties passing urine?”, “do you get any burning sensation when you pass urine?”, “has there been any change to the smell and colour of your urine?”, “have you noticed any blood in your urine?”
Specifically asks about past history of operations as a child - “did you have any operations as a child?”
Family history of male cancer - “does anyone in your family have prostate or testicular cancer?”
Weight loss - “have you had an recent unintended weight loss?”
Smoking - “do you smoke?”, “how much do you smoke in a day?”, “how long have you smoked for?”
Sexual health symptoms - “when was your last sexual contact?”, “was this with a regular or casual partner?”, “did you use condoms?”, “have you had any discharge from your penis?”
Asks about history of trauma - “have you ever had trauma to your testicles?”
Asks about fevers - “have you had any recent fevers?”, “did you measure it? How was it?”
Asks about symptoms of metastasis, e.g. back pain - “do you have any other symptoms like back pain?”
ICE
Ideas - “what do you think could have caused your collapse?”
Concerns - “is there anything that your worried about regarding your collapse?”
Expectations - “what were you hoping we would do for you today?”
Ask why the patient decides to present now and not earlier - “did anything influence your decision to come now and not earlier?”
DH
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
Examination
Asks to examine patient and conducts examination with patient lying down:
Explains procedure and offers chaperone - “I’d like to examine you now by having a look and feel of your testicles. You will have to lie on the couch for this examination? Is this ok with you? Would you like a chaperone to be present in the room to ensure that you are safe?”
Washes hands
Confirms swelling in scrotum
Examines for tenderness
Comments on size/shape of lump
Pays attention to patient comfort at all stages
Counselling
Explains findings to patient in terms that they can understand
Explains what the possibilities are - “it is possible that it is cancer, however it may also be several other things such as infection of the testes or a cyst”
Explains that will refer for an ultrasound scan/to urology department - “Following the examination, I’ll be referring you to the urology department who are doctors that specialises in conditions of the male organ”
Safety-netting
“If you have not heard from the hospital within one week you should contact me”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll write on a piece of paper for you to take home with you.”
