Station 81
Hailey Davies
Age: 39 year old female
Full Case
Patient’s Data
Patient’s name: Hailey Davies
Age: 39-year-old female
Past medical history:
- No known medical conditions.
Drug and Allergy History
- No Known Drug Allergy
- Not currently on any medication
Recent notes/ consultation
- No recent GP consultations recorded
Patient booked routine appointment to discuss concerns
Patient's Story (Role player’s brief)
Patient’s Story
You are Hailey Davies, a 39-year-old female.
Opening Statement: Hi doctor, I’ve had a lump in my throat for a few weeks now and I’m really worried about it.
If asked to elaborate: You’ve been feeling a persistent lump sensation in your throat for over four weeks. It’s not painful, and you’re not having any difficulty swallowing. You’ve not lost any weight, and you haven’t noticed any night sweats, nausea, vomiting, or loss of appetite. You don’t have heartburn, tummy (abdominal) pain, or any changes in your bowel or bladder habits. You frequently clear your throat and swallow saliva even when you’re not eating or drinking anything.
If asked about stress or emotional wellbeing: You’ve been feeling very stressed lately because your boyfriend was recently diagnosed with testicular cancer 5 weeks ago. He’s currently awaiting surgery. This news has been emotionally overwhelming, and you’re finding it hard to cope at work. You work as an accountant, and due to the stress, you’ve made two significant mistakes recently. Your employer has issued warnings, and this has added to your anxiety.
Social History: You do not smoke, drink alcohol, or use illicit drugs.
Ideas: You suspect that the lump in your throat could be a sign of cancer
Concerns: You’re concerned this could be something serious, like cancer, and feel very anxious about it.
Expectations: You’re hoping the doctor can arrange some tests or scans to rule out anything serious.
Say NO to any other questions asked outside of the details already provided in the scenario.
Marking Scheme
Data Gathering and Diagnosis
- Ask when the patient first noticed the sensation of a lump in the throat.
- Ask whether the sensation is constant or if it comes and goes (intermittent symptoms are more typical of globus sensation, while constant symptoms may suggest structural or more serious causes like malignancy).
- Ask if there is any associated throat pain.
- Ask if she has noticed any lumps or swellings in the neck.
- Ask if she has any difficulty swallowing (dysphagia) or pain when swallowing (odynophagia).
- Ask if she experiences heartburn, or a sour taste in the mouth, which may suggest acid reflux.
- Ask about symptoms of postnasal drip, such as a runny nose or mucus dripping down the back of the throat.
- Ask about any nausea or vomiting, if present, ask whether the vomiting has included blood.
- Ask about red flag symptoms: unintentional weight loss, night sweats, persistent hoarseness, or changes in the voice.
- Ask if she has noticed any particular triggers for the throat sensation (e.g., stress, certain foods, caffeine, time of day).
- Ask if she frequently clears her throat or finds herself “dry swallowing” (swallowing without any food or liquid, often just swallowing saliva)
- Ask about any recent emotional stress, including anxiety or difficult life events.
- Ask about smoking history, alcohol use, and occupational exposures (e.g., voice strain, dust, fumes).
- Give a likely diagnosis of globus sensation.
Example of explanation to patient
Hailey, thank you for sharing everything with me today, I can hear how much this has been worrying you, especially with everything going on in your personal life. I understand that you’re quite concerned this lump sensation might be something serious, like cancer, and you were hoping for a scan to rule that out.
From what you’ve told me, and based on the fact that you’ve had no weight loss, no difficulty swallowing, no voice changes or other red flag symptoms, this doesn’t sound concerning for cancer at this stage. What you’re describing actually sounds quite like a condition we call globus pharyngeus, have you come across that term before?
It’s where you feel a lump in the throat, but when we examine the area, there’s no actual lump there. That doesn’t mean what you’re feeling isn’t real, far from it, but it usually isn’t due to anything harmful. It’s a very common symptom, and it can often be brought on or made worse by stress and emotional strain. Given what you’ve been dealing with recently, especially around your partner’s health and the stress at work, it’s very possible that this is playing a role. The good news is that once we get on top of the stress and support your wellbeing, this sensation usually improves.
However, I would still like to invite you in for a face-to-face appointment so we can take a proper look at your neck and throat, just to make sure there’s nothing we’re missing.
I know you’ve had a look yourself and haven’t noticed anything unusual, which is reassuring, but an examination allows us to check for any lumps, swellings, or subtle changes that might not be visible. Would that be okay with you?
You mentioned that you would like to have a scan, and I completely understand your concern. At this stage, based on the information you have provided and the absence of any red flag symptoms, a scan or referral is not necessary. However, if anything changes, such as a worsening of your symptoms or if we find anything concerning during the examination, we will certainly take the appropriate next steps, which may include arranging further investigations or referring you to a specialist.
In the meantime, there are a few strategies that may help ease your symptoms. Would you like me to talk you through them?
One option is to consider some stress management approaches, such as mindfulness, talking therapies like Cognitive Behavioural Therapy, or gentle physical activity such as yoga. Some patients also find relaxation apps like Headspace helpful. Do any of these sound like something you might be open to trying?
If work has been particularly overwhelming, I can also provide you with a short-term fit note. A bit of time away might give you the space to reset and focus on your wellbeing. What do you think?
In addition, many people with this kind of throat sensation find themselves frequently clearing their throat or swallowing even when there is no need to. This can actually make the feeling more noticeable. One simple tip is to sip chilled, fizzy water when the urge to clear your throat arises, this can help settle the reflex and reduce discomfort.
Would you like to explore any of these options further?
Management
Management
- Offer a face-to-face appointment for further assessment, including examination of the neck and throat.
- Acknowledge that stress and anxiety may be contributing factors and recommend support strategies such as Cognitive Behavioural Therapy (CBT), mindfulness, yoga, regular exercise, or relaxation apps like Headspace.
- Provide vocal hygiene advice, including reducing caffeine intake, avoiding habitual throat clearing or dry swallowing, and suggesting sipping chilled carbonated water when the urge arises.
- Offer a short-term fit note as work-related stress is impacting her health and performance.
- Reassure the patient that, given the absence of red flag symptoms, a scan or referral is not indicated at this stage.
- Advise that if symptoms persist, worsen, or if anything concerning is found on examination, further investigation, including a referral to a specialist may be necessary.
- Safety-netting Advice: Advise the patient to seek urgent medical attention if the throat sensation becomes constant or noticeably worsens or she develops any new symptoms such as difficulty swallowing, voice changes, unexplained weight loss, pain, or any visible lumps or swellings.
- Offer follow-up appointment in 3 to 4 weeks to assess progress and review response to the current management plan.
Learning point from this station:
Globus sensation is a subjective feeling of a lump or foreign body in the throat, often described as “something stuck,” even though no actual obstruction is found. It is sometimes referred to as globus pharyngeus.
Common causes include, gastro-oesophageal reflux disease (GORD), psychological factors such as anxiety and stress, increased upper oesophageal sphincter pressure, pharyngeal irritation or inflammation which may lead to increased sensitivity of the throat, contributing to the globus sensation. (e.g. pharyngitis, tonsillitis, postnasal drip from chronic sinusitis), and oesophageal motility disorders (e.g. cricopharyngeal spasm).
Most cases can be effectively managed in primary care through a careful history, exclusion of red flag symptoms, and appropriate examination. Over-referring can lead to unnecessary and invasive investigations, increase patient anxiety, and potentially worsen the symptom.
However, referral to ENT for urgent flexible nasoendoscopy should be considered if the sensation is persistent and constant (not intermittent), or if it is associated with any of the following:
- Pain on swallowing (odynophagia)
- Difficulty swallowing (dysphagia)
- Unexplained weight loss
- Night sweats
- Persistent hoarseness
- History of smoking or significant alcohol use
These features may suggest a more serious underlying pathology such as malignancy and warrant urgent (2-week wait) assessment.