Table of Contents
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.
Introduction
- Wash hands
- Introduce self
- Ask Patient’s name, DOB and what they like to be called
- Explain examination and obtain consent
Generic questions (may be required to differentiate between Cushing’s syndrome and hypothyroidism)
General
- What did you notice first when you developed this condition?
- Do you have any long-term conditions requiring you to take steroids?
- Have you noticed changes in your appearance?
Work down body
- Have you noticed mood changes?
- Do you get intolerant of heat or cold?
- Have you had any change in your periods?
General inspection
- Central adiposity
- Intra-scapular fat pad
- Hirsutism
- Osteoporosis effects, e.g. kyphosis
- Around bed: inhalers, nebulisers, oxygen (may be used in COPD or interstitial lung disease)
Hands and arms
- Capillary glucose stick marks on finger pulps (secondary diabetes)
- Pigmentation (Cushing’s disease)
- Deforming polyarthritis (a reason for corticosteroid use)
- Thin skin and bruising
- Poor wound healing
Face
- Inspection: cushingoid-like facial features (‘facial mooning’), facial plethora, hirsutism, acne, telangiectasia, butterfly rash (SLE)
- Inside mouth: oral thrush, buccal pigmentation (Cushing’s disease)
- Listen for hoarse voice
- Visual fields (bitemporal hemianopia in pituitary adenoma)
Neck
- Intrascapular fat pad
- Supraclavicular fat pads
Chest and abdomen
- Skin thinning
- Classical purple striae
- Lipodystrophy from insulin injections (secondary diabetes)
- Signs of any conditions requiring prolonged steroid use (e.g. organ transplant scars, hyperexpanded chest in COPD)
- Proximal myopathy (check resisted shoulder abduction, then ask patient to stand up with arms crossed)
To complete
- Thank patient
- ‘To complete my examination, I would measure blood pressure, dipstick test urine for glucose, and formally assess visual fields.’
- Summarise and suggest further investigations you would do after a full history, for example:
- 24 hour urinary free cortisol
- Overnight/low dose dexamethasone suppression test
