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INSTRUCTIONS FOR THE DOCTOR

This is a long case.

Please take a history. The facilitator will give you the results of the examination on request. Then negotiate a management plan with the patient.

Scenario

Costa Rinaldi is a 36-year-old man. He rarely comes to see the GP but has booked an appointment today because his girlfriend sent him. They want a family but have not achieved a pregnancy after a year without using contraception. Costa’s girlfriend has a child from a previous relationship.

The following information is on his summary sheet:

  • Past medical history

  • Chickenpox aged 11

  • Medication

  • Nil

  • Allergies

  • Nil

  • Immunisation

  • Nil recorded

  • Social history

  • Works as an engineer.

INSTRUCTIONS FOR THE PATIENT, COSTA RINALDI

You are 36 years old and work hard as an engineer. Over the last few years you have put on weight and now have a BMI of 35.5 kg/m2. You have always been keen to have a family and were delighted to meet Brenda. You want to start a family with her.

You have a great sex life but it is getting you down that Brenda is not pregnant. You have not used contraception for a year. You have a constant reminder that the lack of pregnancy is probably your problem, as Brenda’s 6-year-old daughter from a previous relationship lives with you.

This problem is beginning to affect your work and your relationship with Brenda. You do not smoke and you drink at least five bottles of wine a week. You have heard that some childhood infections can cause infertility and you are worried that the chickenpox is to blame. Brenda has sent you to this appointment.

You have no genitourinary symptoms.

The following information is on your summary sheet:

  • Past medical history

  • Chickenpox aged 11

  • Medication

  • Nil, no supplements

  • Allergies

  • Nil

  • Immunisation

  • Nil recorded

  • Social history

  • Works as an engineer.

INSTRUCTIONS FOR THE FACILITATOR

Clinical examination findings

On specific request please give the doctor the following results:

Pulse 74

BP 136/82 mmHg

Height 1.75 m

Weight 108.8 kg

BMI 35.5 kg/m2

No gynaecomastia

Abdominal examination—normal

Hair distribution—normal

Genitalia—normal testicular and penile examination; no varicocele.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open-ended questions to explore Costa’s ideas, concerns and expectations about the problem and the consultation.

Specific questions1

General health—fever, systemic malaise, weight loss

Sexual function/genitalia

  • — Frequency of coitus

  • — Libido, exclude erectile dysfunction, ejaculatory failure, ...

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