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OSCE examinations Flashcards

(36 cards)

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1
Q

Hip exam structure

A

Start with patient lying down:

  • Look
  • Feel
  • Move
  • Special test (Thomas)

Patient standing up:

  • Look
  • Function (gait)
  • Special test (Trendelenburg)

If time: neurovascular integrity

  • Dorsal and sole of foot sensation
  • Dorsalis pedis, posterior tibial, CRT
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2
Q

Hip exam: Thomas test

A
  1. Pt lying supine
  2. Hand in hollow of lumbar spine
  3. Passively flex hip
  4. Feel for flatting of lumbar spine (pushing down into your hand)

Positive = non-flexed thigh lifts up off bed = fixed flexion deformity

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3
Q

Hip exam: Trendelenburg test

A
  1. Sit on chair with patient stood in front of you
  2. Ask pt to hold onto your shoulders
  3. Hands on hips, thumbs over ASIS
  4. Ask pt to stand on one leg at a time (good leg first)

Normal = pelvis tilts UP on unsupported side
Positive (abnormal) = pelvis DROPS on unsupported side

Positive = aBductor instability

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4
Q

Knee examination structure

A

Start with patient lying down:

  • Look (including measure thigh circumference)
  • Feel (including patellar tap + sweep test)
  • Move
  • Special tests

With patient stood up:

  • Look
  • Function (gait)

If time, neurovascular integrity:

  • Dorsalis pedis, posterior tibialis, CRT
  • Sensation on dorsal and sole of foot
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5
Q

Knee exam: anterior and posterior drawer test

A
  1. With pt supine, flex knee to 90º
  2. Start by looking for posterior sag from side (PCL injury)
  3. Sit on foot, forearm on tibia
  4. Hands behind knee, thumbs on tibial tuberosity
  5. Pull tibia forward
  6. Push tibia backwards

Positive anterior drawer = ACL injury
Positive posterior drawer = PCL injury

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6
Q

Knee exam: McMurray’s

A
  1. Flex knee and hip to 90º
  2. Hold foot, internally rotate foot
  3. Hold knee with thumb+index finger on each side of joint line
  4. Straighten knee (still internally rotated) - FINDING
  5. Repeat with foot externally rotated, and on other side

Positive test = popping/clicking/pain = meniscal tear

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7
Q

Knee exam: collateral ligament stress test

A
  1. Flex knee to 15º
  2. Hold foot with one hand, support knee with other
  3. Apply pressure to each side of knee

Positive = laxity = MCL/LCL weakness

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8
Q

What special tests do you do for a knee exam?

A
  1. Anterior and posterior drawer (ACL, PCL)
  2. Lachman’s (alternative to anterior drawer) (ACL)
  3. Collateral ligament stress test (MCL, LCL)
    4 McMurray’s (meniscus)
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9
Q

GALS: screening questions

A
  1. Do you have any pain or stiffness in your joints, muscles or back?
  2. Can you dress yourself completely without any difficulty?
  3. Can you walk up and down stairs without difficulty?
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10
Q

GALS exam: spine

A

Cervical spine ROM:

  • lateral flexion
  • flexion
  • extension
  • rotation

Lumbar spine:

  • flexion
  • confirm flexion by placing fingers on vertebrae and watching for separation
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11
Q

GALS exam: arms

A

Shoulders:
- “Put both hands behind your head” = aBduction, external rotation, elbow flexion

Hands:

  • Squeeze MCP joints
  • Pronation and supination
  • Power grip (“squeeze my fingers”)
  • Fine pincer grip (“touch your thumb to each finger”)
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12
Q

GALS exam: legs

A

Hips and knees:

  • Patellar tap
  • Active flexion (“bring your knee to your chest”)
  • Passive internal rotation

Feet:
- Squeeze MTP joints

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13
Q

Foot and ankle exam: general structure

A

Patient sat on bed at 45º:

  • Look
  • Feel (temperature, squeeze all joints + Achilles tendon)
  • Move (active + passive)
  • Special tests (Simmonds’)

Patient standing:

  • Look
  • Function (gait)

If time, neurovascular integrity:

  • Sensation on plantar surface of hallux, MTPs + heel
  • Sensory level if suspected neuropathy
  • Ankle jerk
  • Dorsalis pedis, posterior tibialis, CRT
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14
Q

Foot and ankle: Simmonds’ test

A
  1. Pt prone with foot hanging off edge of bed
  2. Squeeze calf muscle and observe ankle plantarflexion

Absence of plantarflexion = Achilles tendon rupture

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15
Q

Shoulder exam: test for previous dislocation

A

Apprehension:

  1. pt lying supine
  2. elbow flexed to 90º, shoulder abducted to 90º, fingers pointing towards head
  3. force external rotation

Apprehension = previous dislocation

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16
Q

Shoulder exam: teres minor injury

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A

Hornblower’s test:

  1. elbow flexed, shoulder abducted, forearm horizontal
  2. active external rotation against resistance

Weakness = TMi injury

17
Q

Shoulder exam: Hawkin’s test

Study These Flashcards
A
  1. elbow flexed, shoulder abducted
  2. force internal resistance

Pain = impingement syndrome (subacromial)

18
Q

Shoulder exam: supraspinatus test

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A

Jobe’s (empty can) test:

  1. arm straight, abducted to 90º, 45º angle from body
  2. “hold a can of coke, and empty it”
  3. force adduction

Pain/difficulty = supraspinatus injury

19
Q

Shoulder exam: subscapularis test

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A

Gerber’s lift off test:

  1. back of hand on lumbar spine
  2. isolate arm at wrist
  3. “push against me”

Pain/difficulty = subscapularis injury

20
Q

Shoulder exam: teres minor and infraspinatus injury

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A

Resisted external rotation:

  1. external rotation position
  2. “push against me” - apply inward pressure

Pain/difficulty = teres minor or infraspinatus injury

Hornblower’s will detect teres minor injury, so if Hornblower’s is negative but this is positive = infraspinatus injury

21
Q

Elbow exam special tests: Golfer’s elbow test

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A

Resisted wrist flexion:

  1. extend elbow + supinate forearm (“hold straight arm out, palm up”)
  2. support elbow, palpate medial epicondyle
  3. passively extend wrist
  4. ask pt to FLEX wrist against resistance

Golfer’s elbow = pain over medial epicondyle

22
Q

Elbow exam special tests: Tennis elbow

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A

Cozen’s test (resisted wrist extension):

  1. extend elbow, pronate forearm, + make a fist (superman pose)
  2. support elbow, palpate lateral epicondyle
  3. “cock your wrist back and hold it there”
  4. apply force to wrist to force flexion

Tennis elbow = pain over lateral epicondyle

23
Q

Hand exam structure (assume MSK + neuro)

Study These Flashcards
A
  1. Look
    2a. Feel (palpate joints + palms, temperature, CRT, pulses)
    2b. Sensation (“feel” for neuro exam)
    3a. Move (for ROM)
    3b. Motor (for nerves)
  2. Function
  3. Special tests
24
Q

Hand exam: sensation

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A
  1. outside of little finger (ulnar)
  2. outside of index finger (median)
  3. first dorsal web space (radial)
25
Hand exam: movements
Do all of these movements actively, then repeat passively if limited ROM Fingers: - flexion + extension (can also assess trigger finger here) - abduction + adduction Thumb: - adduction + abduction - opposition Wrist: - flexion + extension (prayer and reverse prayer) - ulnar and radial deviation Elbow: - pronation + supination
26
Hand exam: motor assessment
Radial: - wrist extension against resistance - finger extension against resistance (fingers together + straight, try to bend them at the MCPs) Ulnar: - finger abduction against resistance (splay fingers, push against index + little finger) Medial: - thumb abduction against resistance
27
Hand exam: function
1. Power grip ("squeeze my fingers tightly") 2. Pincer grip ("squeeze my finger with your thumb+index fingers) 3. Pick up a small object
28
Hand exam: special tests
Tinel's test (for carpal tunnel) - tap over carpal tunnel - tingling in medial distribution = positive test Phalen's test (carpal tunnel) - maximum forced wrist extension for 60s (reverse prayer sign) - reproduction of carpal tunnel sx = positive test Froment's sign (ulnar pathology) - ask pt to hold a piece of paper between their thumb and index finger - pull paper away and observe thumb shape - thumb DIP flexion = positive Froment's sign Allen's (arterial insufficiency) - palpate radial pulse - palpate ulnar pulse - occlude both pulses - ask pt to make a tight fist for 10 seconds, then open it (palm should be white) - release one pulse at a time to see if blood returns - repeat, releasing the other pulse first
29
Cerebellar exam: head
Nystagmus (present): - move finger in + direction quickly Speech (slurred, staccato): - "british constitution" - "baby hippopotamus"
30
Cerebellar exam: upper limbs
Tone (hypotonic): - as per UL neuro exam Power (may confound co-ordination findings): - as per UL neuro exam Co-ordination: - rebound test (arms out, palms down, eyes closed, push each arm down and assess for overshoot - arm bouncing back past starting point) - finger-nose test (past pointing/dysmetria, intention tremor) - dysdiadochokinesia (slowness, difficulty)
31
Cerebellar exam: lower limbs
Only assess tone and power if not done in ULs Co-ordination: - heel-shin test (dysmetria, intention tremor)
32
Cerebellar exam: posture/gait
Stability when sitting: - sit pt on side of bed with arms crossed over chest - observe for truncal ataxia Stability when standing (only if stable sitting) Romberg's test (only if stable standing): - hands around pt to reassure them that they won't fall - ask pt to close eyes - observe for sensory ataxia Gait: - ataxic gait = wide-based, unsteady with lateral veering, irregular steps - heel-toe walk (almost impossible if cerebellar lesion)
33
Parkinson's exam: TRAP structure
Tremor (resting): - ask pt to hold arms out in front of them (tremor should stop) Rigidity (cogwheel): - assess tone as in UL neuro exam - ask pt to tap knee with other hand to reinforce hypertonia Akinesia (more accurately, bradykinesia): - thumb to each finger quickly - pretend to play piano Postural instability: - assess gait - features of Parkinson's: hesitancy, shuffling, festination (speeding up inadvertently), loss of arm swing, retropulsion (falling backwards as feet rush ahead in festination)
34
Parkinson's exam: other tests
Glabellar tap: - ask pt to fix eyes onto wall - tap forehead and observe blinking - normal = blinking stops after 2-3 taps - Parkinson's = blinking continues Speech (slow, monotonous): - assessed initially, but can ask pt to repeat name and DOB Writing (micrographia) Function: - undo a button - handle some coins
35
Diabetic foot exam: vascular
- Temperature - Dorsalis pedis, posterior tibialis - Popliteal if above are absent - CRT of hallux
36
Diabetic foot exam: neurological
Reflexes: ankle jerk Sensation: - light touch - pressure (10g monofilament) - say you would do pin prick and temperature Proprioception Vibration: - 128Hz tuning fork - 1st MTPJ, move proximally if absent

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