Itchy, bleeding anal lump

Instructions

You are a medical student on placement in general practice. Your next patient is Jack Walsh, 54, presenting with an itchy, bleeding lump at his anus for three months.

1. 1

   Take a focused history

2. 2

   Perform a focused examination

3. 3

   Outline to the examiner:

   • Your most likely diagnosis and differentials
   • Next steps in management, including relevant investigations

• You do not need to summarise your findings to the examiner
• Verbalise your examination; the examiner will give findings on request
• Any intimate examination is performed on a manikin