Knee OSCE Exam Flashcards Preview

Phase 2B Medicine > Knee OSCE Exam > Flashcards

Flashcards in Knee OSCE Exam Deck (33)
Loading flashcards...
1

What are the first 3 things you should do on introduction to the examination?

Wash hands
Introduce yourself
Confirm pt details (name/DOB)

2

How should you explain the knee examination to the patient?

"Today I need to examine your knee joint. This will involve looking, feeling & moving the joint."

3

How would you check the pt's understanding & gain consent?

"Does everything I've said make sense?"
"Are you happy for me to examine your knee joint?"

4

How would you like to position your pt?

Expose pt's legs: ideally pt should be wearing shorts.
Position the pt standing upright.

5

What crucial question should you ask before beginning the examination?

Ask the pt if they currently have any pain.

6

What are the 3 main components to a knee examination?

Look
Feel
Move

7

What 2 things are you looking for when you first look at your pt's knees?

- Gait
- Inspect the knees (anteriorly & posteriorly)

8

What are you looking for in the pt's gait?

- Is the pt demonstrating a normal heel strike / toe off gait?
- Is each step of normal height (increased stepping seen in foot drop)
- Is the gait smooth & symmetrical?
- Any obvious abnormalities? (antalgia / waddling / broad based)

9

When inspecting the knees, what are you looking for on the anterior aspect?

- Scars: previous surgery / trauma
- Swellings: effusions / inflammatory arthopathy / septic arthritis / gout
- Asymmetry / Leg length discrepancy
- Valgus or varus deformity
- Quadriceps wasting: suggests chronic inflammation / reduced mobility

10

When inspecting the knees, what are you looking for on the posterior aspect?

- Scars
- Asymmetry
- Popliteal swellings: Baker's cyst / popliteal aneurysm

11

When you move onto the 'feel' part of the examination, how would you like to assess the pt?

Ask pt to lay on the bed.

12

What 2 things should you do first when feeling the knee joint?

- Assess temperature: increased temp mays suggest inflammation / infection
- Palpate the quadriceps tendon: whilst leg extended (tenderness suggests synovitis)

13

You need to palpate the knee joint. How would you like to position the knee?

Knee flexed at 90o.

14

On palpation of the knee joint, which areas need to be palpated?

- Patella: palpate borders for tenderness / effusion
- Tibial tuberosity: tenderness -> ? Osgood Schlatter disease
- Head of the fibula: irregularities / tenderness
- Tibial & femoral joint lines: irregularities / tenderness
- Collateral ligaments: both medial & lateral
- Popliteal fossa: feel for any obvious collection of fluid (eg. a Baker's cyst).

15

Where should you measure the quadriceps circumference?

20cm above tibial tuberosity.
Compare legs.

16

You need to conduct a patellar tap. What will this detect?

Can detect larger effusions.

17

Describe how you'd conduct a patellar tap.

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

18

You need to conduct a sweep test. What does this detect?

Sweep test is useful for detecting small effusions.

19

Describe how you'd conduct a sweep test.

1. Empty the suprapatellar pouch with one hand whilst also emptying the medial side of the joint using an upwards wiping motion.
2. Now release your hands and do a similar wiping motion downwards on the lateral side of the joint.
3. Watch for a bulge or ripple on the medial side of the joint.
4. The appearance of a bulge or ripple on the medial side of the joint suggests the presence of an effusion.

20

What are the 2 types of movement you should be assessing?

Active: pt performs mvt. Observe for a restricted range of movement & signs of discomfort.

Passive: pt relaxes & allows you to move the joint freely. Feel for crepitus as you move the joint. Observe any restriction of movement.

21

What 2 movements should you assess on active movement?

- Knee flexion: "Move your heel as close to your bottom as you can manage." Normal ROM: 0 - 140o

- Knee extension: "Straighten your leg out as best as you are able to."

22

What movements should you assess on passive movement?

Knee flexion & extension
Hyperextension: elevate both legs by the heels: note any hyperextension (<10o is normal).

23

What are the 2 'special tests' required for knee examination?

1. Anterior / Posterior drawer test
2. Collateral ligament testing (Lateral collateral ligament & medial collateral ligament)

24

Describe how you'd carry out the Anterior / Posterior drawer test.

1. Flex pt's knee to 90o.
2. Inspect for evidence of posterior sag, as this can give a false positive anterior drawer sign.
3. Wrap your hands around the proximal tibia with your fingers around the back of the knee.
4. Rest your forearm down the pt's lower leg to fix its position.
5. Position thumbs over the tibial tuberosity.
6. Ask pt to keep their legs as relaxed as possible.
7. Pull the tibia anteriorly: significant mvt suggests ANTERIOR cruciate laxity / rupture
8. Push the tibia posteriorly: significant movement suggests POSTERIOR cruciate laxity / rupture.

25

A patient has healthy cruciate ligaments. What would you find on the Anterior / Posterior drawer test?

There should be little or no movement noted.

26

You want to assess the Lateral Collateral Ligament. Describe how you'd do this.

1. Extend the pt's knee fully.
2. Hold the pt's ankle between your elbow & side,
3. Place your R hand along the medial aspect of the knee.
4. Place your L hand on the lower limb (calf or ankle).
5. Push steadily outward with your R hand whilst applying an opposite force with the L.

27

If the LCL is damaged, what would you find?

Your hand should detect the lateral aspect of the joint opening up.

28

You want to assess the Medial Collateral Ligament. Describe how you'd do this.

1. Extend the pt's knee fully.
2. Hold the pt's ankle between your elbow & side.
3. Place your R hand along the lateral aspect of the knee.
4. Place your L hand on the lower limb (eg. calf or ankle)
5. Push steadily inward with your R hand whilst applying an opposite force with the L.

29

If the MCL is damaged, what would you find?

Your hand should detect the medial aspect of the joint opening up.

30

If the knee appears stable, how might you further assess the collateral ligaments?

Repeat all tests, but with the knee flexed at 30o.
At this position, the cruciate ligaments are not taught, so minor collateral ligament laxity can be more easily detected.