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.
| Observations (practice nurse) | BP 138/84 mmHg, HR 76 /min, weight 92 kg, fingerprick glucose 11.2 mmol/L |
|---|---|
| From the file | Type 2 diabetes 12 years. Metformin 1 g twice daily, gliclazide MR 60 mg daily, atorvastatin 20 mg daily. Last HbA1c 8.6%. No known drug allergies. |
Your tasks are to:
- Perform a focused neurological examination of the lower limbs. Verbalise each step to the examiner; findings will be provided as you perform them.
- Summarise your findings to the examiner and state your most likely diagnosis and the differential diagnoses.
- 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.
- You are not required to examine the back or the upper limbs.
This is a 10-minute station, with 2 minutes of reading time.