Station - Instructions for candidate
You are a final-year medical student in a Bunbury general practice.
Linh Le is a 68-year-old woman attending a general practice in Bunbury with a two-month history of a small right groin lump and a dragging ache. A recent superficial graze to her right shin and long-standing varicose veins are noted in her history. She is currently stable and has no handover suggesting acute deterioration.
| Referral information | Lin is a 68-year-old woman attending the Bunbury general practice with a two-month history of a right groin lump and a dragging ache. |
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Results provided:
Bilateral groin ultrasound
| Item | Value | Reference range |
|---|---|---|
| Report | 2.0 cm right femoral canal defect containing preperitoneal fat; non-reducible during examination; no bowel within the sac; left groin normal | No hernia |
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 126 g/L | 115-155 g/L |
| White cell count | 7.8 x 10^9/L | 4.0-11.0 x 10^9/L |
| Neutrophils | 4.9 x 10^9/L | 2.0-7.5 x 10^9/L |
| C-reactive protein | 3 mg/L | <5 mg/L |
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.4 mmol/L | 3.5-5.0 mmol/L |
| Creatinine | 82 umol/L | 45-90 umol/L |
| eGFR | 64 mL/min/1.73 m2 | >60 mL/min/1.73 m2 |
Right lower limb venous ultrasound
| Item | Value | Reference range |
|---|---|---|
| Report | No deep vein thrombosis identified | No deep vein thrombosis |
Your tasks are to:
- Take a focused history of the groin lump and relevant background, including medications and allergies.
- Perform a focused examination of both groins, the femoral and saphenofemoral regions, the lower limb and regional lymph nodes. Describe what you would look for and do; the relevant findings will be provided by the examiner.
- Request appropriate investigations. Results will be provided by the examiner if appropriately indicated.
- State the most likely diagnosis and two to four differentials, with brief justification.
- Outline the initial management plan, including analgesia, referral and safety-netting.
- Explain the diagnosis and agreed plan to the patient in plain language.
- You do NOT need to summarise your history and examination findings to the examiner.
- Please verbalise your examination to the examiner; findings will be provided when you request or demonstrate the relevant step.
- You do not need to write a prescription or perform a procedure.
- The examiner will not ask you questions at the end.
This is a 15-minute station, with 2 minutes of reading time.