Makindo Medical Notes

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

💡 This OSCE is rarely examined on real patients – more likely on a manikin. Still, know the full process, including consent, chaperone, and documentation.

🔑 Introduction (WIPER)

• W – Wash: Hand hygiene 🧼
• I – Introduce: Yourself, confirm details 🙂
• P – Permission: Explain gently and gain consent ✅
• E – Expose & Equipment: Gloves, lubricant 🧴, tissues, apron
• R – Reposition: Left lateral (hips/knees flexed), sheet for dignity

📊 Common Rectal Findings

🧭 Examination Steps

• Positioning: Offer a chaperone 👥, ensure privacy. Left lateral is most common.
• Preparation: Gloves 🧤, lubricant 🧴. Warn before each step.
• Inspection: Part buttocks, inspect for haemorrhoids, fissures, fistulae, warts, bleeding.
• Digital Exam:
  • Lubricated index finger → apply gentle pressure at anal verge.
  • Advance slowly on inspiration → reassure throughout.
  • Assess anal tone (squeeze + rest).
  • Sweep circumferentially for masses, tenderness, impacted stool.
  • Males → palpate prostate: size, symmetry, midline sulcus, tenderness, nodularity.
  • Females → comment on cervix/uterus if palpable through anterior wall.
• Glove Check: Blood, pus, mucus, melaena.
• Closure: Remove glove safely, clean patient, thank them, wash hands.

🌟 OSCE Pearls

• Always offer a chaperone and document this ✅
• Never forget the glove check – examiners love this step 🧤
• Describe prostate properly: “enlarged, smooth, rubbery, with a preserved sulcus” vs “hard, irregular, obliterated sulcus”
• Say you would complete exam: abdominal exam, external genitalia, urinalysis, stool occult blood, colonoscopy if indicated.

📚 References

• Talley & O’Connor – Clinical Examination
• Geeky Medics: Rectal OSCE
• OSCEstop – GI Examination