Endocrinology
CANDIDATE INSTRUCTIONS
You are a resident year 1 doctor in your Acute Medical Unit rotation. Jack Mackson, a 56-year-old male, is known to have uncontrolled Type 2 Diabetes Mellitus now complains of a tingling pain in both his feet. You are not required to take a history.
Please perform a focused physical exam
Explain your clinical impression and workup plan to the patient
2 Minutes Reading Time
10 Minutes Station Time
Total 12 Minutes
EXAMINER INSTRUCTIONS
Timing Instructions: At 8 minutes, stop the candidate and ask the following questions:
Question 1: What are some further examinations and investigations you would do?
Answer 1:
Examinations: peripheral vascular examination, complete lower limb neurological examination
Bedside test: capillary blood glucose, urine dipstick
Laboratory: HbA1c, lipid profile, U&Es, albumin:creatinine ratio
Special test: ABPI with doppler ultrasound
Question 2: How would you manage this patient?
Answer 2:
Control blood glucose level
Improve lifestyle: smoking cessation, diet and exercise
Pain management
Encourage regular diabetic foot clinic visit
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Diabetic Neuropathy
PATIENT INSTRUCTIONS
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Name: Jack Mackson
Date of birth: 8th November 1968
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If asked: “I’ve got this numbness in my legs for about 4 days, and it’s getting worse!”
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General inspection: Nil. Has appropriate foot wear
Gait: unbalanced, continues to stumble when asked to perform.
Inspection: Nil
Palpation:
Cool and pale feet
Capillary refill time 2-3 seconds
Dorsalis pedis pulse not palpable; Posterior tibial pulse palpable
Sensory: via monofilament
Via monofilament: Bilateral loss of sensation in a non-dermatomal pattern from mid-shin downwards
Vibration: Unable to feel vibration unless performed on knee
Proprioception: Unable to answer correctly on proprioception unless performed on knee
Reflexes: Intact knee, achilles and Babinski reflexes
MARK SCHEME
Introduction
General Inspection
Gait
Palpation
Sensory
Reflexes
Completion
Questions
Patient Scores
Enter Your Score Here: /32
SCORE GUIDE
Pass: 16 - 32
Borderline Pass: 7 – 15
Fail: 0 - 7
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