Medicine · Examination

Numb and tingling feet in a man with diabetes - GP

EasyYear 5 · Curtin style · 10 min + 2 min reading · 3 tasks

2 min reading · 10 min station · reminders at 2 min

Station - Instructions for candidate

You are a junior doctor working in a general practice in Northam.

Rahul Patel, a 61-year-old farmer with type 2 diabetes for 12 years, has mentioned during his diabetes review that his feet have been numb and tingling for about six months. He has no back pain and no weakness. He is lying on the examination couch with his lower legs exposed. A tendon hammer, a 128 Hz tuning fork, a 10 g monofilament, a neurotip and cotton wool are on the table.

Your tasks are to:

  1. Perform a focused examination.
  2. Summarise your findings and state your most likely diagnosis and differential diagnoses to the examiner.
  3. Outline your initial management plan to the examiner.
  • You do NOT need to take a history; the relevant history is provided and the patient will answer brief clarifying questions.
  • Please verbalise your examination to the examiner; findings will be provided on request.
  • You are not required to examine the back or the upper limbs.

This is a 10-minute station, with 2 minutes of reading time.

Ask the examiner

Say what you would examine or request, the way you would in the station. Nothing is named until you ask for it.

Whatever the examiner recognises is revealed below. Or pick a numbered item to reveal it blind.

Investigations

Ask for a category the way you would in the station: “Can I have the obs and a set of bloods?”

Examination

Say what you would examine and how; the examiner reports what you would find.