Flashcards in GALS OSCE Exam Deck (31)
What 5 things should you do as part of your introduction?
Confirm pt details
What part(s) of the pt would you like to ask them to expose?
Pt's chest, upper and lower body
What should you ask before you begin the examination?
Does the pt have any pain anywhere?
What are the 3 screening questions you MUST ask?
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?
You want to assess the pt's gait. What instructions should you give the pt?
Ask the pt to walk to the end of the room & back whilst you observe.
When observing the pt's gait, what 5 things are you looking for?
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)?
You want to inspect the pt. What instructions should you give the pt?
Ask pt to stand in the anatomical position(!) whilst you inspect from the front, side & behind for any abnormalities.
You are looking at the pt from the front. What 5 things are you assessing?
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
You are looking at the pt from the side. What are you looking for in their spine?
Cervical spine: Inspect for Hyperlordosis (spondylolisthesis)
- Inspect degree of thoracic kyphosis (normal is 20-45o)
- Hyperkyphosis - >45o
Lumbar spine: assess degree of lordosis
- Loss of lumber lordosis (flat back syndrome) - compression fractures / ankylosing spondylitis
You are looking at the pt from the side. Apart from the spine, which other 3 areas should you be assessing?
Knee joints: degree of flexion / hyperextension
- Low arch profile: (pes planus) flat feet
- High arch profile: (pes cavus) eg. Charcot-Marie-Tooth disease
Toe clawing: eg. plantar fascial fibromatosis
You are now looking at the pt from behind. What 6 features should you be assessing?
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)
You ask the pt to place their hands behind their head. What does this allow you to assess?
Shoulder abduction & external rotation, also elbow flexion
You ask the pt to hold their hands out in front of them, palms facing down & fingers outstretched. What are you looking for?
Inspect the backs of the hands for asymmetry, joint swelling & deformity.
You ask the pt to supinate their hands. What are you looking for?
Inspect the muscle bulk of the palms (thenar / hypothenar eminences). Note any other abnormalities.
What instructions are you going to give the pt such that you can observe the pt's hand function?
Ask pt to make a fist.
What are the 2 types of grip you want to assess?
How would you assess power grip?
Ask pt to squeeze your fingers & assess grip strength (comparing between the hands)
How would you assess precision grip?
Ask pt to touch each finer in turn to their thumb.
How would you detect possible inflammatory arthropathy?
Gently squeeze across the metacarpophalangeal (MCP) joints. Observe for non-verbal signs of discomfort. Tenderness may indicate inflammatory arthropathy.
How should you position the pt if you want to examine their legs?
Lying down on the examination couch.
What are the first 2 things should you assess when assessing the legs?
- 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)
Why would you conduct a 'patellar tap'?
To detect large effusions
How would you conduct a patellar tap?
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.
You then assess the feet. What are you looking for?
Which foot joints should you squeeze across to assess for inflammatory arthropathy?
Metatarsophalangeal (MTP) joints.
Observe for non-verbal signs of discomfort.
You observe the patient's spine. From behind, what do you look for?
Evidence of scoliosis.
You observe the pt's spine. From the side, what do you look for?
Abnormalities of lordosis or kyphosis.
How do you assess lateral flexion of the cervical spine?
Ask the pt to tilt their head to each side, moving their ear towards the shoulder.
How do you assess lumbar flexion?
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).