GALS OSCE Exam

Question 1

What 5 things should you do as part of your introduction?

Answer 1

Wash hands
Introduce yourself
Confirm pt details 
Explain examination
Gain consent

Question 2

What part(s) of the pt would you like to ask them to expose?

Answer 2

Pt’s chest, upper and lower body

Question 3

What should you ask before you begin the examination?

Answer 3

Does the pt have any pain anywhere?

Question 4

What are the 3 screening questions you MUST ask?

Answer 4

Do you have any pain in your muscles, joints or back?

Are you able to dress yourself completely without any difficulty?

Are you able to walk up & down the stairs without any difficulty?

Question 5

You want to assess the pt’s gait. What instructions should you give the pt?

Answer 5

Ask the pt to walk to the end of the room & back whilst you observe.

Question 6

When observing the pt’s gait, what 5 things are you looking for?

Answer 6

Symmetry of the pt’s gait
Smoothness - heel strike, toe off
Turning - are they able to turn quickly without any issues?
Is each step of normal height ? (increased stepping height seen in foot drop)
Is there any evidence of pain (antalgic gait)?

Question 7

You want to inspect the pt. What instructions should you give the pt?

Answer 7

Ask pt to stand in the anatomical position(!) whilst you inspect from the front, side & behind for any abnormalities.

Question 8

You are looking at the pt from the front. What 5 things are you assessing?

Answer 8

1. Shoulders: assess bulk & symmetry
2. Elbow extension: assess carrying angle (normal is 5-15 degrees)
3. Quadriceps: assess bulk & symmetry
4. Knees: Swelling / deformity / asymmetry?
5. Feet: Note any mid foot or fore foot deformity / asymmetry

Question 9

You are looking at the pt from the side. What are you looking for in their spine?

Answer 9

Cervical spine: Inspect for Hyperlordosis (spondylolisthesis)

Thoracic spine:

• Inspect degree of thoracic kyphosis (normal is 20-45o)
• Hyperkyphosis - >45o

Lumbar spine: assess degree of lordosis

• Hyperlordosis
• Loss of lumber lordosis (flat back syndrome) - compression fractures / ankylosing spondylitis

Question 10

You are looking at the pt from the side. Apart from the spine, which other 3 areas should you be assessing?

Answer 10

Knee joints: degree of flexion / hyperextension

Foot arches:

• Low arch profile: (pes planus) flat feet
• High arch profile: (pes cavus) eg. Charcot-Marie-Tooth disease

Toe clawing: eg. plantar fascial fibromatosis

Question 11

You are now looking at the pt from behind. What 6 features should you be assessing?

Answer 11

Shoulder muscles: wasting / asymmetry may suggest joint pathology

Spinal alignment: look for evidence of scoliosis

Iliac crest alignment: pelvic tilt may suggest hip abductor weakness

Gluteal muscle bulk: muscle wasting suggests reduced mobility

Popliteal swellings: Baker’s cyst / popliteal aneurysm (pulsatile)

Hind-foot abnormalities

Question 12

You ask the pt to place their hands behind their head. What does this allow you to assess?

Answer 12

Shoulder abduction & external rotation, also elbow flexion

Question 13

You ask the pt to hold their hands out in front of them, palms facing down & fingers outstretched. What are you looking for?

Answer 13

Inspect the backs of the hands for asymmetry, joint swelling & deformity.

Question 14

You ask the pt to supinate their hands. What are you looking for?

Answer 14

Inspect the muscle bulk of the palms (thenar / hypothenar eminences). Note any other abnormalities.

Question 15

What instructions are you going to give the pt such that you can observe the pt’s hand function?

Answer 15

Ask pt to make a fist.

Question 16

What are the 2 types of grip you want to assess?

Answer 16

Power grip

Precision grip

Question 17

How would you assess power grip?

Answer 17

Ask pt to squeeze your fingers & assess grip strength (comparing between the hands)

Question 18

How would you assess precision grip?

Answer 18

Ask pt to touch each finer in turn to their thumb.

Question 19

How would you detect possible inflammatory arthropathy?

Answer 19

Gently squeeze across the metacarpophalangeal (MCP) joints. Observe for non-verbal signs of discomfort. Tenderness may indicate inflammatory arthropathy.

Question 20

How should you position the pt if you want to examine their legs?

Answer 20

Lying down on the examination couch.

Question 21

What are the first 2 things should you assess when assessing the legs?

Answer 21

Assess:

• Passive full knee flexion & extension (feeling for crepitus)
• Passive internal rotation of the hip joint (hip and knee joint should be flexed to 90o for assessment)

Question 22

Why would you conduct a ‘patellar tap’?

Answer 22

To detect large effusions

Question 23

How would you conduct a patellar tap?

Answer 23

1. Empty the supra patellar pouch by sliding your left hand down the thigh to the patella.
2. Keep your left hand in position & use your right hand to press downwards on the patella with your fingertips.
3. If fluid is present, you will feel a distinct tap as the patella bumps against the femur.

Question 24

You then assess the feet. What are you looking for?

Answer 24

Swelling
Callosities
Deformity

Question 25

Which foot joints should you squeeze across to assess for inflammatory arthropathy?

Answer 25

Metatarsophalangeal (MTP) joints.

Observe for non-verbal signs of discomfort.

Question 26

You observe the patient’s spine. From behind, what do you look for?

Answer 26

Evidence of scoliosis.

Question 27

You observe the pt’s spine. From the side, what do you look for?

Answer 27

Abnormalities of lordosis or kyphosis.

Question 28

How do you assess lateral flexion of the cervical spine?

Answer 28

Ask the pt to tilt their head to each side, moving their ear towards the shoulder.

Question 29

How do you assess lumbar flexion?

Answer 29

1. Place 2 fingers on the lumbar vertebrae.
2. Ask pt to bend & touch their toes.
3. Observe your fingers as they flex (they should move apart).
4. Observe your fingers as the pt extends their spine to return to a standing position (your fingers should move back together).

Question 30

What 3 things should you do to complete the examination?

Answer 30

Thank pt - tell them to get dressed(!)
Wash hands
Summarise findings

Question 31

What further assessments may be required?

Answer 31

• Perform a focused examination on joints with suspected pathology
• Request further imaging of joints with suspected pathology (x-ray / CT / MRI)