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 doctor covering the emergency department. You are asked to see Waleed Khan, a 35-year-old accountant, complaining of a lump in his groin. Please take a history and perform a relevant examination.
Patient History:
It's all a bit embarrassing, really, but you've got a groin lump. You noticed the lump last week, and it's been there ever since. It's like you've got a tennis ball under your skin. It's making things like wearing pants very awkward and sometimes a bit uncomfortable. You haven't noticed any change in size with coughing, straining or standing for prolonged periods. It was uncomfortable to touch.
You've come in today because you've been getting waves of 5/10 abdominal pain today at the site. Paracetamol didn't seem to make much of a difference. You've been feeling sick on and off, and actually vomited once this morning - just normal food content. You last opened your bowels the night before yesterday and passed urine as normal without straining. There was no blood in your stool. You have had no difficulty swallowing, indigestion, fever or weight loss.
Ideas, Concerns, Expectations:
You are not sure what this is. You can concerned the lump is cancer. You wish to get it checked out.
Past Medical History:
Appendicectomy 10 years ago. Asthma.
Drug History:
Ventolin inhaler PRN. Steroid inhaler.
NKDA.
Family History:
None.
Social History:
You are currently working as an accountant. It's good work, and you're able to work from home, so you have plenty of time to go to the gym for your weightlifting.
You don't smoke or drink.
You live with your wife and two young girls at home, where you are normally independent.
Examination Findings:
Left groin mass superior and medial to the pubic tubercle 2x2cm soft
Tender on palpation at the hernia site.
Non-reducible. Non-pulsatile
Positive cough impulse
No guarding or signs of peritonitis.
Differentials:
Direct Inguinal hernia
To rule out bowel obstruction/ perforation
Incisional hernia if the site of hernia is at the site of incision for appendicectomy
Vascular e.g. saphena varix, femoral artery aneurysm. (would be pulsatile).
Subcutaneous e.g. lipoma, sebaceous cyst.
Lymphoma
Investigations:
Clinical diagnosis. If uncertain, can use ultrasound as first line.
Other abdominal imaging - AXR (bowel dilatation/ free air), CT Abdo (look for obstruction/bowel perforation)
Management: