The OSCE instructions may be non-specific, for example: ‘Examine this patient’s endocrine status.’ This could be Cushing’s syndrome, acromegaly or hypothyroidism. Approach this situation by asking a few generic questions (if allowed) and by doing a general inspection to determine which condition you think is present. Then proceed with the relevant focussed examination to elicit other signs.
Ask Patient’s name, DOB and what they like to be called
Explain examination and obtain consent
Generic questions (acromegaly is usually obvious so ask questions to elicit symptoms you cannot examine for)
What did you notice first when you developed this condition?
Have you noticed a change in your appearance?
Determining if there is active acromegaly
Do you notice excessive sweating?
Do you have high blood pressure?
Other symptoms – work down body
Pins and needles
Change in shoe size
Increased size of feet, hands, head
Inspect and palpate with patient’s hands on pillow
Dorsum: large, spade-shaped, with signs of osteoarthritis
Palms: sweaty, doughy/boggy texture to palms, capillary glucose stick marks on finger pulps (secondary diabetes)
Signs of carpal tunnel syndrome (release scar or loss of thenar eminence and/or loss of sensation in median nerve distribution)
Blood pressure (hypertension)
General: coarse facial features, acne, enlarged nose and ears, macrognathia (large mandible), look for hypophysectomy scar under upper lip