OSCEs for Medical Finals, First Edition.

Hamed Khan, Iqbal Khan, Akhil Gupta, Nazmul Hussain, and Sathiji Nageshwaran.
2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.
Chapter 11
Rectal
Checklist P MP F
HELP
H: Hello (introduction and gains consent)
E: Exposure
L: Lighting
P: Positions correctly (lying on side, fetal position with hips
and knees exed), asks if the patient is in any pain
Washes hands
Explains purpose and routine of examination in a sensitive
manner
Explicitly asks for consent before proceeding
Explains that having a CHAPERONE is essential for the
examination, and requests one from examiner
Explains repositioning on couch (e.g. Please remove your
trousers and undergarments down to your knees, and lie on
your left hand side on the couch with your knees tucked in
to your chest and your bottom close to the edge)
States intention to draw the curtain/step outside to allow
privacy to undress
Gathers appropriate equipment: tray, gloves, tissues,
lubricating gel
States intention to optimise lighting
Wears gloves
Parts buttocks and inspects for: skin tags, ulcers, abnormal
growth, warts, ssures, stulas
Tells patient before inserting nger
Inserts one lubricated nger into anus
Examines sensation of the perianal skin
Checklist P MP F
Instructs patient to bear down and squeeze on nger to
examine anal tone
States intention to feel for:
Entire wall of rectum by moving nger 180 degrees in
either direction:
Polyps
Lumps
Faecal impaction/hard stool
Prostate: Comments on:
Size
Symmetry
Midline sulcus
Texture
Tells patient before removing nger
Inspects glove of nger for melaena, mucus, fresh blood
Removes gloves and disposes of them appropriately in
clinical waste
Thanks patient, says examination is complete and allows
patient to re-dress with dignity and privacy
States intention to complete examination by examining
abdomen
States intention to perform neurological examination of
lower limbs (if told by examiner that anal tone was reduced)
Washes hands
Presents ndings
Offers appropriate differential diagnosis
Suggests appropriate further investigations and management
OVERALL IMPRESSION: