OSCE

Question 1

What are you LOOKING for in a spinal exam?

Answer 1

Posture of the head, neck and shoulders
Thoraco-lumbar scoliosis (standing and bending forward)
Normal (or abnormal) curvature of the spine

Question 2

What are you FEELING for in a spinal exam?

Answer 2

Cervical ribs
Enlarged lymph nodes
Spinous processes
Muscle bulk or spasm in paraspinal muscles
Asymmetry in iliac crest heights or pelvic tilt
Sacroiliac joints
Chest expansion if AS suspected

Question 3

What MOVEMENTS do you test in a spinal exam?

Answer 3

Flexion and extension of cervical spine
Rotation of cervical spine
Lateral flexion of cervical spine
Flexion and extension lumbar spine
Lateral flexion of lumbar spine

Question 4

Which special test needs to be done in a spinal exam?

Answer 4

Schober’s test (the one with the measuring tape)

Question 5

What are you LOOKING for in a hand exam?

Answer 5

Sclerodactyly
Psoriatic nail changes
Dupuytren’s
Mallet finger
Gouty tophi
Clawing
Swelling at any joints
Ulnar deviation
Bouchard’s and Heberden’s nodes
Swan neck deformity
Boutonniere deformity
‘Z’ shaped thumb
Muscle wasting

Question 6

What are you FEELING for in a hand exam?

Answer 6

Temperature
Tenderness at MCPs
Feel all joints

Question 7

What movements need to be done in a hand exam?

Answer 7

Close fist
Finger extension and flexion
Finger abduction and adduction
Thumb opposition

Question 8

How do you test an RA patient’s hand function?

Answer 8

Power of pincer grip
Fine pinch (picking up coin)
Tripod grip (holding a pen)
Power grip
Hook grip

Question 9

How do you test the innervation in the hand?

Answer 9

Dorsal:
- Base of thumb (radial)
- Pinkie (ulnar)
- Tip of index finger (median)
Palmar
- Index finger (median)
- Pinkie (ulnar)
- Lateral proximal part of thumb (radial)

Question 10

What signs not on the hands would you look for in a hand exam?

Answer 10

Episcleritis/scleritis - RA
Malar rash - SLE

Question 11

What are you LOOKING for in a wrist exam?

Answer 11

Deformity
Swelling
Scars
Muscle wasting

Question 12

What are you FEELING for in a wrist exam?

Answer 12

Distal radio-ulnar joint
Ulnar styloid
Anatomical snuff box

Question 13

Which movements do you do in a wrist exam?

Answer 13

Flexion and extension
Radial flexion and ulnar flexion
Pronation and supination

Question 14

What special tests are there in a wrist exam?

Answer 14

Finklestein’s (hand in ulnar deviation, push thumb in ulnar direction - positive result = pain = De Quervain’s tenosynovitis)
Eichoff’s (thumb across palm of hand, make fist and bend in ulnar deviation - positive result = pain = De Quervain’s tenosynovitis)
Scaphoid compression (positive test = pain in anatomical snuff box = scaphoid fracture)
Tinnel’s (tap volar aspect of carpal tunnel - positive test = pain or neuro symptoms over median nerve distribution = carpal tunnel syndrome)
Phalen’s (maximally flex wrist positive result same as Tinnel’s)

Question 15

What are you LOOKING for in an elbow exam?

Answer 15

Deformity
Carrying angle
Swelling over lateral aspect (effusion)
Swelling over olecranon process (bursitis)
Gouty tophi
Psoriatic plaques
Rheumatoid nodules on proximal extensor surfaces of forearm

Question 16

What are you FEELING for in an elbow exam?

Answer 16

Olecranon
Lateral and medial epicondyles
Radial head
Bony contours
Valgus and varus stress (MCL and LCL)

Question 17

Which movements do you test in an elbow exam?

Answer 17

Flexion and extension (and hyperextension with shoulder at 90 degrees)
Pronation and supination

Question 18

What are the special tests in an elbow exam?

Answer 18

Tinel’s (tap cubital tunnel posterior to medial epicondyle - positive test = symptoms exacerbated = cubital tunnel syndrome)
Froment’s test (hold piece of paper between thumb and index finger and resist examiner’s attempt to pull away - positive test = ulnar nerve palsy)
Tennis elbow (flex elbow to 90 degrees in pronation, ask patient to extend wrist or index finger against resistance - positive test = pain at lateral epicondyle and may be referred down extensor aspect of arm)
Golfer’s elbow (flex elbow to 90 degrees in supination, ask patient to flex wrist against resistance - positive test = pain at medial epicondyle and may be referred down te flexor aspect of arm)

Question 19

What are you LOOKING for in a hip exam?

Answer 19

Muscle mass with patient standing
Gait
Patient lying down -
- Erythema or skin changes
- Swelling
- Bruising
- Scars
- Attitude of limb

Question 20

What are you FEELING for in a hip exam?

Answer 20

Greater trochanter
Groin (mid-point and medially)

Question 21

Which movements do you test in a hip exam?

Answer 21

Flexion (passive and active)
Internal rotation (passive)
External rotation (passive)
Adduction (passive)
Abduction (passive)

Question 22

What are the special tests in a hip exam?

Answer 22

Trendelenurg test
Limb lengths (true and apparent)

Question 23

What are you LOOKING for in a shoulder exam?

Answer 23

Contour of shoulder
Deltoid and trapezius muscle bulk
Deformities of bones
Scars
Scapular asymmetry
Swellings and scars in the axillas

Question 24

What are you FEELING for in a shoulder exam?

Answer 24

Sternoclavicular joint, along clavicle, acromioclavicular joint, acromion process
Long head of biceps
Scapula spine and body

Question 25

What are the movements tested for in a spinal exam?

Answer 25

Forward flexion Abduction (ask about painful arc) External rotation (elbows by sides) Internal rotation (hand on back)

Question 26

What are the special tests in a shoulder exam?

Answer 26

Hawkins-Kennedy (shoulder flexed, elbow at 90 degrees, internally rotate arm - positive result = pain = impingement) Jobe's test (shoulder flexed, arm straight, thumb pointing down, get patient to resist downward force - positive result = pain exacerbated = rotator cuff tear) Sulcus sign Anterior and posterior drawer (patient supine on bed, stabilise shoulder girdle with one hand, draw humeral head anteriorly and posteriorly) Anterior apprehension (patient lying supine, elbow flexed, externally rotate shoulder) Posterior apprehension (patient lying supine, shoulder and elbow both flexed at 90 degrees, exert pressure through the elbow) Scarf test Infraspinatous and teres minor weakness (elbows by sides and flexed at 90 degrees, get patient to resist your medial force) Subscapularis (patient put hand just above buttocks and try to resist you pushing their hand towards them)

Question 27

What are you LOOKING for in a foot and ankle exam?

Answer 27

Examine footwear Swelling Nail changes Bruising Deformity Get patient to stand on tip toes Look for ulcers and callosities on sole of foot Gait

Question 28

What are you FEELING for in a foot and ankle exam?

Answer 28

Lateral malleolus and lateral ligament complex Anterior joint line Medial malleolus and deltoid ligament Achilles tendon Bade of 5th metatarsal (pinkie toe) Metatarsal heads on plantar surface Pulses Sensation

Question 29

Which movements do you test for in a foot and ankle exam?

Answer 29

Dorsiflexion and plantarflexion Inversion and eversion Metatarsal phalangeal movement

Question 30

What are the special tests in a foot and ankle exam?

Answer 30

Grind test Anterior drawer test Mulder's click test (interdigital space on plantar aspect of foot) Simmond's test (patient's feet hanging off edge of chair, squeeze calves - positive test = foot does not move = Achilles tendon rupture)

Question 31

What are you LOOKING for in a knee exam?

Answer 31

Limb alignment Valgus/varus deformity Muscle mass Baker's cysts Gait Erythema or skin changes Bruising Scars Swelling

Question 32

What are you FEELING for in a knee exam?

Answer 32

Temperature Tibial tuberosity Patella tendon Medial and lateral joint line Medial and lateral collateral ligaments Popliteal fossa Bursa

Question 33

Which movements do you test for in a knee exam?

Answer 33

Flexion and extension (active and passive - feel for crepitus in passive)

Question 34

What are the special tests in a knee exam?

Answer 34

Straight leg raise