This is a story told as notes on an exam.
(If you do find it realistic, PLEASE remember it's a play exam. No real medicine here.)
MEDICAL REPORT ON PATIENT “JAMIE”
Jamie contacted me seeking a full physical examination as he hasn’t had one for a long time. Jamie was in London temporarily on a work assignment and so took the opportunity for an impromptu exam. The only requests from Jamie were for a thorough exam and it was for the doctor to determine exam details..
On arrival at Jamie’s hotel accommodation and after some brief introductions a full health assessment was conducted.
A history was taken. He reports that his job is occasionally stressful but this is balanced by fulfilment in his job. He copes satisfactorily with any occasional stress, although the nature of his work can sometimes require long hours. Jamie’s lifestyle is balanced and includes time for socialising with friends. J's use of alcohol is occasional and controlled. His diet is broadly satisfactory, although time pressure leads to light (and sometimes no) breakfasts. Some meals are takeaways, although patient demonstrated self-critical awareness of good eating habits. Eg, he aims to consume 5 fresh/fibre portions qd. He has recently been a regular sports player and attends the gym 3x p/w, mostly doing work with weights. N-smoker.
On examination, J presents as a well nourished man of 35 in excellent shape. He is 1.9m in height. Jamie's weight, shoulder, chest, waist and inside leg measurements are all in proportion for an active man of his height and age. Jamie's build is mesomorph with developed musculature. His physical stance and whole body movements are excellent. Flexion tests all satisfactory. Neurological reactions all normal. Patient declined whole skin examination on this occasion but observation of his skin during examination showed no lesions or sun damage of any concern. Observation of body hair composition showed that J had some hair on his chest, legs, arms and buttocks. These hairy and pubic hair was untrimmed.
Oral examination showed good teeth and gum condition although patient did not tolerate extensive examination of his throat or tonsils on this occasion. Patient's scalp and hair condition are good. Examination of the patient's ears show some wax but with a clear visualisation of the eardrum on both sides. Pupil dilation was normal. Focus and eye movement tests were normal. External examination of the patient's throat, thyroid and lymph nodes NAD.
Ditto in physical examination of the axillae. Breast examination showed no cause for concern. No lesions, bumps or epidermal anomalies. Examination of J's nipples provided some overstimulation. This was noticeable from his penis showing some signs of bulging through his underwear at the point of breast examination.
Anterior and posterior auscultation both satisfactory. No wheezing, coughing or evidence of obstruction in the lungs. Heart rate was normal (pulse 62 bpm, though elevated at start of the exam. Probable white coat reading as patient had just removed all clothing prior to heart rate being taken). BP normal, standing and sitting.
At this point the patient was now completely undressed. The earlier erection from the breast examination subsided/patient's penis flaccid. Patient consented/comfortable removing all clothing when requested.
Abdo exam NAD. Liver not enlarged. Spleen normal size. No pain felt in any quadrant. R lateral exam of pancreas and kidneys (necessarily limited) showed no cause for concern. Abdominal auscultation was normal. Gurgling bowel sounds with no tingling. No flatulence at any stage in exam in spite of extensive examination of the patient's bottom. No indication of any hernia inguinal or umbilical. Patient declined DRE on this occasion. Patient's anus showed no lesions, discharge or sign of external haemorrhoids. Skin felt normal.
3 stage assessment of the patient's temperature was good. Oral, axilla and rectal with rectal core temperature precisely normal.
Examination of J' external genitalia ( with consent) was very satisfactory but with advisory follow up. Scrotum felt normal to posterior and anterior palpitation. Detailed examination of L & R testes showed healthy, well sized organs with no physical evidence of lesion, epidydimal disorder or other abnormality. Patient's testes are well descended. No trans illumination on this occasion. Patient uncmsed. J's penis showed no sign of irregularity. No lesions or discharge. Prepuce, circumference and length all good on examination. Upon examination the patient gained an erection. Erectile function excellent. Patient has concerns over tightness of foreskin, though repeated retraction during examination did not seem to show discomfort. However, foreskin was quite tight when penis relaxed so more extensive examination and discussion advised if patient has concerns. Sexual therapy via discussion and further examination may help (eg re areolar sensitivity). Patient provided a semen sample. Strong, good functioning. Ejaculation was firm with good volume.
Patient's lower limbs are in good state. Musculature even L & R. No restriction in movement. Femoral pulses good. Ditto pedal pulses. Both feet fully sensitive. Toes whole and functional. Nails healthy. No interdigital fungus or discomfort.
Patient's urine sample all clear. Declined blood sugar check but no glucose in urine.
Very positive outcome to examination. No cause for concern for this well informed, healthy patient with a high degree of condition. Follow-up not required but recommended, if patient wishes, for repeat exam with more time spent on areas of interest and importance to him.