Makindo Medical Notes

Related Subjects: |Breast Anatomy and Examination (OSCE) |Shoulder examination(OSCE) |Testicular examination(OSCE) |Hernia Examination (OSCE) |Rectal examination (OSCE)

I doubt this would occur as an exam OSCE unless in a Manekin so be prepared.

Introduction Using the WIPER Acronym

• W – Wash: Wash your hands thoroughly.
• I – Introduce: Introduce yourself and confirm the patient’s details.
• P – Permission: Gain consent by explaining the procedure in detail.
• E – Expose & Equipment: Expose the patient appropriately and gather all necessary equipment.
• R – Reposition: Position the patient comfortably, typically lying on their left side (fetal position with hips and knees flexed) or at a 45-degree angle, ensuring privacy.

Background

Detailed Examination Steps

• Patient Positioning:
  • Ensure the patient is comfortable and fully aware of the procedure.
  • Offer a chaperone and ensure total privacy (e.g., using a screen at the door).
• Hand Preparation:
  • Wash your hands, don gloves, and apply lubricating gel to the index finger.
• Perineal Inspection:
  • Gently part the buttocks and inspect the perianal skin for:
  • Skin tags, ulcers, abnormal growths
  • Warts, fissures, fistulas
  • External haemorrhoids and any signs of active bleeding
• Digital Examination:
  • Inform the patient before inserting the lubricated finger into the anus.
  • Gently insert one lubricated finger and assess the sensation of the perianal skin.
  • Ask the patient to "bear down" and squeeze your finger to evaluate anal tone.
  • Carefully palpate the entire rectal wall by rotating your finger approximately 180° in each direction to detect:
    • Polyps or lumps
    • Signs of faecal impaction or hard stool
  • In male patients, perform a prostate examination by palpating for:
    • Size and consistency
    • Symmetry and the presence of a midline sulcus
• Glove Inspection & Closure:
  • Inform the patient before withdrawing your finger.
  • Inspect your glove for any signs of melaena, mucus, or fresh blood.
  • Dispose of gloves properly, thank the patient, wash your hands again, and document your findings.