Station - Instructions for candidate
You are a final-year medical student in a surgical outpatient clinic.
Emmanuel Santos, a 61-year-old man, is attending a surgical outpatient clinic about a wound underneath his right big toe that he has noticed for about three weeks. He reports that the area has not been painful. No observations or investigation results are available at the start of the station.
Results provided:
Blood tests
| Item | Value | Reference range |
|---|---|---|
| Haemoglobin | 122 | 130-170 g/L |
| White cell count | 11.8 | 4.0-11.0 x 10^9/L |
| C-reactive protein | 42 | <5 mg/L |
| Glucose | 15.2 | 4.0-7.8 mmol/L |
| HbA1c | 86 | 20-41 mmol/mol |
| Creatinine | 118 | 60-110 umol/L |
| eGFR | 55 | >60 mL/min/1.73 m2 |
Lower-limb pressure studies
| Item | Value | Reference range |
|---|---|---|
| Right ankle-brachial pressure index | 0.48 | 0.90-1.40 |
| Right toe pressure | 22 | >50 mmHg |
| Left ankle-brachial pressure index | 0.96 | 0.90-1.40 |
| Left toe pressure | 78 | >50 mmHg |
Right foot radiograph
Plantar soft-tissue defect beneath the right first metatarsal head with surrounding soft-tissue swelling. No gas, cortical destruction or foreign body.
imaging other - read aloud by the examiner
The image shows a soft-tissue defect under the right first metatarsal head with surrounding swelling. The adjacent bone cortex remains intact. There is no visible gas or foreign body.
Look up an example image: Radiopaedia diabetic foot radiograph
Your tasks are to:
- Take a focused history of the presenting problem and relevant background, including past medical history, medications, allergies and social circumstances.
- Perform a focused examination of the right foot wound with peripheral vascular and neurological examination. Describe to the examiner what you would look for or do; the relevant findings will be provided to you.
- Request appropriate investigations; results will be provided by the examiner if appropriately indicated.
- State the most likely diagnosis and two to four differentials, with brief justification.
- Outline the initial management plan, including the key treatment, referral and safety-netting.
- You do NOT need to summarise your findings to the examiner.
- You do not need to write a prescription or perform a procedure.
- Please verbalise the examination steps and request investigations clearly; findings and results will be provided by the examiner when appropriately requested.
This is a 10-minute station, with 2 minutes of reading time.