Consent

Question 1

Consent mr x for a Pr exam

Answer 1

To further investigate the symptoms you’ve been having I’d like to perform an examination of the back passage.

Have you ever had one before?

It will involve me placing a gloved and lubricated finger into the back passage to feel for any abnormalities in the rectum or prostate. The examination does not take long and as I am removing my finger I will ask you to squeeze to assess muscle tone. The examination shouldn’t take long, it might be uncomfortable but shouldn’t be painful and we can stop at any point.

Does that sound okay? Are you happy to proceed with the examination?

Due to the nature of the examination I will also ask another member of staff to come into the room as a chaperone, they will be there to support you throughout the examination. Is that okay? Do you have a preference as to if this is a make or female?

Okay so if you’re happy to continue I’ll ask you to go behind the curtain and remove all clothing from the waist down. There’s a sheet on the bed that you can cover yourself with. Then lay on your left side facing the wall with your knees up at your chest ans let me know when you’re ready for me to come back in.

Question 2

Steps of PR exam

Answer 2

1. Consent
2. Instruct to position
3. Dr & chaperone enter
4. Inspect outside (anal tags/fissures)
5. Lubricate finger
6. Ask patient if they are happy for me to begin the examination. Ok I will begin now you might feel some pressure in the back passage
7. 360 degree sweep round. That’s not particularly painful?
8. Can you squeeze down on my finger as I remove it?
9. Inspect finger, wipe patient.
10. That’s the examination complete, I’ll leave some additional tissue there if you need it. Please get dressed and come back to take a seat when you are ready there’s no rush.

Question 3

Consent for GALS

Answer 3

I’d like to do an examination to screen for any muscle or joint problems.

This involves me assessing how you walk ans then asking you to do some movements of your arms, legs ans back. Would that be okay?

I have a few questions to ask before we begin the examination.

Question 4

Steps for GALS examination

Answer 4

1. Ask 3 questions.
2. General inspection
3. Assess gait.
4. Arms behind head (abduction, external rot, elbow flex)
5. Hands out in front (palms down)
6. Flip hands over
7. Make a fist
8. Squeeze fingers
9. Pincer grip
10. MCP squeeze

Legs
1. Passive knee flexion & extension.
2. Passive internal rot
3. Patellar tap
4. MTP squeeze

Spine
1. Ear to shoulder
2. Flexion (fingers for schobers)

Question 5

Steps of thyroid exam

Answer 5

Look
- Tremor
- Hands
- eyes (+ from above)
- neck with tongue out
- neck when swallowing
- pretibial myxoedema

Feel
- temp of hands
- pulse
- lymph nodes
- thyroid (+tongue out +swallow)
- listen for bruits

Move
- H test
- Saccadic eye movement/nystagmus
- stand for proximal myopathy