Rectal Examination


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an FY1 in A&E

Patient: 40 year old male patient has presented with a fresh PR bleed

Task:

  • Perform a digital rectal examination on this patient
  • You are expected to explain the procedure and gain consent

You are a 40 year old patient who’s been having bright red blood coming from your back passage for the last few weeks.

You’re embarrassed about it but you’re willing to be examined in order to find out the cause of your bleeding.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Role
Clarifies who they are talking to
Asks patient for preferred name


General
Wash hands with gel
Put on gloves & apron


Explanation of procedure
Will be asked to remove clothing from waist to knees with blanket placed over the top
Laying on side with legs pulled up to chest
Might be uncomfortable but should not be painful
Will only last a few seconds
Sweep finger both clockwise and anticlockwise
Asked to squeeze


Consent for procedure
Explains chaperone of same sex will be present
Can stop at any time if in any pain or discomfort
Gains consent from patient and asks if happy to proceed


Inspection
Rash
Skin tags
Fissures
Swelling from anus


Palpation
Insert finger slowly
Note if rectum empty or faeces present
Rectal walls – sweep finger in clockwise and anticlockwise direction. Ensuring all 365 degrees is checked for masses


Prostate
Size
Comments on sulcus between right and side lobes
Comments on consistency (normal / nodular)


Finger removal. Comments if presence of:
Blood on glove
Melena
Mucus


Finishing
Offers patient tissues to clean
Covers patient
Summarises findings



Score