Station - Instructions for candidate
You are a medical student on placement in a general practice in Joondalup.
Dilan Weerasinghe is a 24-year-old warehouse storeman attending a general practice in Joondalup with three months of a dull dragging ache on the left side of his scrotum. The discomfort is affecting him during work and he wants an explanation and plan.
Results provided:
Scrotal ultrasound with Doppler
| Item | Value | Reference range |
|---|---|---|
| Ultrasound report | Multiple serpiginous veins superior and posterior to the left testis, up to 3.2 mm upright with augmentation and reducing when supine; both testes normal in size, echotexture and vascularity; no focal intratesticular lesion | No dilated scrotal veins or intratesticular lesion |
The report describes dilated veins above the left testis that become more prominent with standing and straining and reduce when lying down. Both testes appear normal.
imaging other - read aloud by the examiner
The scan shows several winding fluid-filled channels above the left testis. They become more obvious when the patient strains and become much less visible when he lies down. The testicular tissue on both sides appears even, with no focal lump.
Look up an example image: Radiopaedia varicocele ultrasound
Urinalysis
| Item | Value | Reference range |
|---|---|---|
| Leucocytes | Negative | Negative |
| Nitrites | Negative | Negative |
| Protein | Negative | Negative |
| Blood | Negative | Negative |
| Glucose | Negative | Negative |
| Ketones | Negative | Negative |
| pH | 6.0 | 5.0-8.0 |
| Specific gravity | 1.020 | 1.005-1.030 |
Urinalysis is unremarkable.
Your tasks are to:
- Take a focused history of the presenting problem and relevant background.
- Perform a focused examination of the scrotum and groin, first standing and then supine. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- 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 for each.
- Outline the initial management plan, including treatment, referral and safety-netting.
- Explain the diagnosis to the patient in plain language and agree on a plan with him.
- 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 the relevant step.
- You are not required to perform a procedure or write a prescription.
- The examiner will not ask you additional questions.
This is a 15-minute station, with 2 minutes of reading time.