Simulated Patient Brief — KIM (Lung cancer)
Location: General Practice. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Kim
- Age
- 58 years
- Opening statement
- “I’ve had a nagging cough and shortness of breath for a few weeks, and recently I’ve started coughing up blood. It’s worrying me.”
Dry cough for years, recently more frequent and worsening over the last couple of months. Coughed up blood on a couple of occasions and thought it was from coughing too much. Over the last week, coughing up blood more regularly — sometimes almost every time you cough. Never much; mixed with phlegm. Shortness of breath worse over a similar timeframe. Very tired despite not doing much.
Response to questions
- Open questions: give the change in cough, haemoptysis and breathlessness as above.
- If asked specifically: clothes looser / belt tighter — think you have lost weight but have not weighed yourself. No fevers or night sweats, but very tired. No chest pain, no wheezing. Unaware of TB exposure. Never lived outside the UK, never lived in a hostel/prison/institution, never worked with cattle. Childhood immunisations; unsure about TB vaccine but have a small scar on the shoulder.
Ideas: Worried it is related to smoking.
Concerns: Anxious about the blood; wondering if something serious such as lung cancer.
Expectations: Find out what is wrong and get it sorted.
- COPD
- Hypertension
- No prior history of cancer if asked
- Amlodipine 5 mg once daily
- Salbutamol inhaler when required
- NKDA
- Mother alive, 80 — hypertension and type 2 diabetes
- Dad died from “something to do with his lungs”; you know he coughed up blood but not the diagnosis
Builder. Smoke 20/day now; smoked 35 years; used to smoke ~50/day for about 30 of those years. Alcohol 2–3 beers a week. Moderately active until recently. Live with wife and two children; normally independent with daily activities.
Systems review: no palpitations, no leg swelling, GI and neuro review negative as scripted.