Dermatology
CANDIDATE INSTRUCTIONS
You are a resident year 2 doctor working in the GP Surgery. Mr Mark Jones, a 60-year-old gentleman presents complaining of a suspicious lump over his back.
Please take a complete history from the patient
At 7 minutes, the examiner will stop you to ask you some questions.
2 Minutes Reading Time
10 Minutes Station Time
Total 12 Minutes
EXAMINER INSTRUCTIONS
Timing Instructions: At 7 minutes, stop the candidate and ask the following questions:
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Answer 1: Melanoma
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Answer 2:
Site, Size, Shape, Surface, Margins, Temperature and Tenderness
(A) Asymmetry: The margins are asymmetrical
(B) Borders: The borders are irregular
(C) Colour: The skin lesion is not evenly covered with shades of brown and black
(D) Diameter: The spot is larger than 6 millimetres across
(E) Evolution: The mole is changing in size, shape, or colour.
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Answer 3: Discuss with senior to make a 2-week urgent referral to the dermatologist for examination, investigation, and diagnosis
Picture 1 (Generated using Deep-AI tool): Mr Mark’s skin lesion-
Melanoma
PATIENT INSTRUCTIONS
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Name: Mark Jones
Age: 60 Years Old
Date of Birth: 5th May 1964
Location: GP Surgery
Occupation: Travel Agent
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“I’ve had this lump on my back for the longest time I can remember, but it seems to be getting bigger!”
“A friend of mine told me to get it checked”.
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Site : Upper back
Onset : Present for about 5 years, but getting worse in the recent 6 months
Character : -
Radiating :
Associated symptoms :
1/ Itchiness (Intermittent)
2/ Bleeding (Upon itching)
3/ Tingling and Numbness over the lesion (Intermittent)Timing : Progressively getting worse
Exacerbating : None
Alleviating factors : None
Severity: Nil
NO constitutional symptoms such as Loss of Weight, Loss of Appetite, fatigue and tiredness
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Site: Upper back
Size: Like a 50 cent coin, used to be a 20 cent coin 6 months ago
Shape: Irregular
Surface: Irregular and not smooth
Margins: No well-demarcated
Tenderness: None but itchy
Temperature: Normal
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Ideas: “I think I have skin cancer.."
Expectations: “Can you tell me what do I have?”
Concerns: “Am I going to die because of this skin cancer?”
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Otherwise, NO fever, recent infections
NO headache, chest pain, palpitations, shortness of breath
NO vomiting, diarrhea, abdominal pain.
Normal urinary flow and bowel habits.
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“I often sunbathe in Spain during the Summer. Almost everyday!”
“I don’t use any UV protective sun block”
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Previous hospital admissions: None
Previous surgeries: None
Medical conditions: None
Medications:
None.
Over the counters:
None.
Allergies:
None.
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No history suggestive of skin cancer/ melanoma
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Smoking: Does not smoke
Alcohol: Does not drink alcohol
Recreational drugs: Never
Diet: Eats a well balanced diet
Exercise: Hardly
Ill contacts: No one around me was recently ill
Occupation: Travel agent
MARK SCHEME
Introduction
Chief Complaint
History of Presenting Complaint
Systems Review
Past Medical History
Drug History
Family History
Social History
Questions
Patient Scores
Enter Your Score Here: /36
SCORE GUIDE
Pass: 21 - 36
Borderline Pass: 17 – 20
Fail: 0 - 16
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