Patient Instructions — DANIEL QUICK

Demographics: Daniel Quick, 42-year-old male (DOB: 02/07/1984). Partner in a central city accountancy firm.

Opening Line: "Thank you, doctor. I’ve come in today because I’ve noticed a couple of lumps in my groin that aren’t going away, and they’re starting to worry me."

History of Presenting Complaint (Groin Lumps)

• Onset & Duration: You first felt two distinct lumps in your right groin approximately 8 weeks ago.
• Progression: They have gradually enlarged over the past two months.
• Characteristics: They feel firm and rubbery and are completely painless to touch. They are noticeable mainly when they rub against your trousers when walking or sitting.
• Local Factors: No skin redness, warmth, discharge, cuts, insect bites, or recent leg infections.
• Other Sites: You haven't noticed lumps elsewhere (neck or armpits), although you have not systematically checked.

Systemic Review & Constitutional Symptoms (Disclose upon enquiry)

• Fatigue: Profound, worsening exhaustion over the past few months. You routinely work long days (6:00 AM to midnight), but recently you have struggled to cope. Last week you uncharacteristically overslept and missed an important client meeting.
• Unintentional Weight Loss: You have lost approximately 2 stone (12–13 kg) over the last 3 months without dieting or changing exercise habits. You initially rationalised this as stress.
• Night Sweats: Frequent, drenching sweats over recent weeks that soak through your pyjamas and bedsheets, forcing you to get up and change linen. None during daylight hours.
• Pruritus: Generalized, bothersome skin itching over the past month with no visible rash.
• Negative Review: No fever, persistent cough, haemoptysis, dyspnoea, abdominal pain, jaundice, or changes in bowel or urinary habit. No recent foreign travel.

Past Medical, Family & Social Background

• Medical History: Nil of note. No regular medications or OTC supplements. No known drug allergies.
• Family History: No history of haematological malignancy, other cancers, or chronic autoimmune disorders.
• Social: Happily married to Sienna; two children aged 14 and 16. Smokes 20 cigarettes per day. Drinks roughly 2 units of wine per evening (crucially, alcohol consumption does not induce pain in the lumps). No illicit drug use.
• Sexual history: You have only been with your wife Sienna in the past 20 years, you have used condoms for intercourse since the birth of your youngest child.

Ideas, Concerns & Expectations (ICE)

• Ideas: Wondered if it might be an inguinal hernia from lifting heavy luggage, or swollen glands from an unnoticed minor bug.
• Concerns: With the lumps persisting alongside severe fatigue and drenching sweats, you are quietly terrified it could be cancer.
• Expectations: Expects an examination and blood tests to identify why the lumps are there and what is causing the fatigue.

Acting & Demeanour Guidance

Friendly, professional, but visibly subdued by exhaustion and underlying anxiety. Respond openly to broad, open questions; give direct, brief answers to closed questions. Do not volunteer the drenching night sweats, pruritus, or weight loss immediately - allow the candidate to uncover them through proper systemic enquiry.