Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓
Doctor Instruction:
You are a junior doctor in the General Practice. Takashi Shimura is a 62-year-old male who has presented with dysphagia. Please take a brief history, discuss the potential diagnoses with the patient and the next steps to be taken. Examination is not required.
Patient History:
Takashi Shimura, 62-year-old retired male. You moved from Japan 10 years ago to do research in biochemistry.
4 months ago, you started experiencing some difficulty swallowing. You only decided to come in now as it has really started affecting your diet over the last 2 months. Initially, you were only struggling with solids and you found that you needed to spend more time eating with smaller bites and chewing longer. Then, you found it was hard to eat certain things at all such as red meat and you had to cut it from your diet entirely. You have had to include softer and more mashed foods into your diet. Your average day’s diet includes a cup of coffee and some pudding every morning, followed by soups and soft foods like mashed potatoes for both lunch and dinner.
You are no longer enjoying meals the way you used to and can’t go out with your friends for meals because of how restricted your diet is. Your bowel habits have been the same in terms of frequency, you are still opening them daily. But now that you think about it, the colour of the stool has been much darker as if you’ve been eating black liquorice (which you haven’t)!
If asked directly:
You have experienced some loss of weight, approximately 4 kgs over the last 2 months. Loss of appetite due to difficulty swallowing. You have also been feeling more tired than usual.
Negative symptoms:
No odynophagia
No abdominal pain
No hematemesis
No history of GORD/symptoms of heartburn
No fever, night sweats
Ideas, Concerns, Expectations:
You think this could be something serious. In fact, you searched your symptoms on Google and you’re really scared this might be due to stomach cancer. You are hoping to be reassured that this isn’t cancer.
Past Medical History:
Hypertension
Drug History:
Amlodipine 5 mg OD
NDKA
Family History:
Your father died of lung cancer at 85 years old. Your mother died of old age. No family history of swallowing problems or ‘gastric’ disease to your knowledge.
Social History:
You live at home with your wife.
You smoke 5 sticks a day.
You consume a glass of wine every weekend but not on the weekdays
Patient Questions for the Doctor:
Do you think this is cancer?
What happens next if this is cancer? (doctor should explain need for referral and endoscopy)
How soon will I be seen by the specialist? (within 2 weeks)
What happens during an endoscopy?
Why is an endoscopy necessary? Are there any other options, such as scans?
What happens after cancer is confirmed?
Marking Scheme: