Fatigue, Night Sweats and Weight Loss About to Travel Abroad — Free SCA Practice Case

Character Overview: You are Tom, a 20-year-old university student, about to fly abroad in two days for an archaeology field trip lasting a few months — something you have worked towards and are very excited about. You feel reasonably well in yourself and are inclined to brush off the symptoms and get on the plane. You are polite but keen to be reassured and cleared to travel; you will push back on anything that threatens the trip.

Opening Sentence: "Hi Doctor. I've been more tired than usual and I've lost a bit of weight, and I've had these night sweats where I wake up soaked. I'm flying out for a university archaeology trip in two days, so I just wanted a quick once-over to make sure I'm okay to go."

History if Asked (Data Gathering Phase)

• ●Weight loss: "About four or five kilos over the last month or two, without trying. My clothes are looser."
• ●Night sweats: "Yeah — a few times a week I wake up absolutely drenched, having to change my T-shirt. That's new."
• ●Fatigue: "Really wiped out, more than just uni tiredness. I'm napping in the day, which isn't like me."
• ●Lumps: "I haven't noticed any lumps, but I haven't really looked."
• ●The trip: "It's a big archaeology field project abroad, a few months, part of my course. I fly out in two days. I've been looking forward to it for ages — I really don't want to miss it."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

• ●Ideas: Tom thinks he is probably just run down from a hectic term and end-of-year stress, and that he will pick up once he is away. "I've told myself it's just being run down after a mad term. I figured I'd perk up once I'm out there."
• ●Concerns: He has not let himself think about anything serious; his real fear is not the symptoms but missing the trip. When the possibility of a serious cause is gently raised, he becomes worried but also more anxious about the travel implications. "Honestly, my main worry is being told I can't go. I haven't wanted to think it could be something serious."
• ●Expectations: He expects to be reassured and cleared to fly. "I was hoping you'd say it's nothing and I'm fine to travel."

If Asked — Medical History and Medications

The patient confirms these details only when directly asked.

• ●Past health: "Fit and well normally, no medical problems, no operations."
• ●Medications: "Nothing regular."
• ●Family history: "No family history of cancer or blood problems that I know of."
• ●Vaccinations/travel prep: "I've had my travel jabs sorted for the trip."
• ●Allergies: "None."

Social History and Lifestyle Impact

Tom is a full-time university student living in shared student accommodation.

• ●University and the trip: "Second year. This field trip is a core part of my degree — missing it would set me back a whole year."
• ●Sexual history (if asked sensitively): "I've had a couple of partners over the last year. I haven't always used protection, if I'm honest. I've never had an STI test."
• ●Drugs/alcohol: "I drink at weekends. I've tried cannabis, no injecting drugs."
• ●Travel history: "No recent foreign travel before this. This trip would be my first in a while."

If Asked — Systemic and Lymphoma/HIV Screen

The patient answers these only when directly asked.

• ●If asked about fever: "I've felt hot and shivery at night with the sweats, but I've not taken my temperature."
• ●If asked about lymph node lumps (neck, armpit, groin): "I haven't checked, but now you say it, there might be something in my neck — I'm not sure."
• ●If asked about itch: "Yes, actually — I've been quite itchy all over, no rash though."
• ●If asked about alcohol-induced pain (lymphoma clue): "That's weird — I did get an ache somewhere when I had a drink recently. I thought I imagined it."
• ●If asked about cough, breathlessness, chest symptoms: "No cough, breathing's fine."
• ●If asked about abdominal fullness/early satiety: "Maybe a bit full quickly, now you mention it."
• ●If asked about HIV risk (sexual history): "A couple of partners, not always protected, never tested. I hadn't thought about HIV."
• ●If asked about bruising/bleeding: "No, no unusual bruising or bleeding."

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains the symptoms need urgent investigation before travel: "Urgent? But I feel okay-ish, and I fly in two days. Can't I just get checked when I'm back?" (The tested point is conveying the seriousness of B-symptoms and negotiating staying for investigation, without being heavy-handed.)
• ●If the Doctor raises the possibility of a serious cause such as lymphoma: "Lymphoma? As in cancer? You think it could be cancer?" (The tested point is honest, calibrated communication of a possible serious diagnosis.)
• ●If the Doctor offers an HIV test: "An HIV test? Why — do you think that's likely?" (The tested point is offering HIV testing sensitively and non-judgementally as part of the work-up.)
• ●If the Doctor offers to support delaying the trip with a letter: "If I really can't go now, could you help me sort it with the university so I don't lose the year?"
• ●If the Doctor arranges examination and bloods: "What will the tests involve, and how quickly will I know?"