Osce Exams Flashcards by Daf Stonehewer

What do you comment on in antenatal exam?

Single baby
Comment on linea negra and striations (not stretch marks!)
Longitudinal / transverse / oblique line with
the back in mams left/right?
Cephalic or breach
Baby head fixed 5/5 not fixed 0/5 fully fixed
Symphasis fundal height
Fetal heart 130 to 250

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In CVD exam what is possible stigmata of disease around bedside?

IV FLUIDS, medications, monitors oxygen

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In RESP exam what is possible stigmata of disease around bedside?

Oxygen, sputum pots, peak flow meters

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In Abdo exam what is possible stigmata of disease around bedside?

Feeds- NG, TPN

Vomit bowls

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In Neuro exam of the lower limb what is possible stigmata of disease around bedside?

Motility aids, orthotics, medications

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In CVD exam what do you examine hands for?

Cap refill, Peripheral cyanosis (poor perfusion)
Splinter hemorrhages (infective endocarditis)
Clubbing (cynaotic congenital heart disease, chronic lung disease, inflammatory bowel disease)
Koilonychia (iron deficiency anaemia)
Cap refill time

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In Resp exam what do you examine hands for?

Temperature,
Peripheral cyanosis (potential hypoxia)
Clubbing ( congenital heart disease, chronic lung disease, IBD)
cap refill

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In Abdo exam what do you examine hands for?

Cap refill time ( good marker of hydration status)
Asses skin turgor (another useful marker of hydration status)
Clubbing, koilonychia, leukonychia, palmar erythema (raised oestrogen secondary to hepatic failure)

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Paeds CVE what to look for during general inspection

Nutritional status 
Scars or deformities 
Level of respiratory effort 
Cyanosis 
Obvious dysmorphic syndromes such as Down’s or  Marfan’s syndrome

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Paeds RESP exam what to look for in general inspection?

Nutritional status
Scars or deformities
Level of respiratory effort
Cyanosis

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Paeds abdo exam what to look for in general inspection?

Alertness 
Interest in surroundings 
Jaundice 
Posture (if experiencing abdominal pain their knees may be drawn up to chest or lying very still) 
Rash (dermatitis herpetiformis)
Bruising
Nutritional status

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In Abdo exam what do you check hands for?

Cap refill, skin turgor, clubbing, koilonychia, leukonychia, palmar erythema

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What is leukonychia?

White spots on nails, Caused by hypoalbuminaemia.

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What is clubbing?

Deformity of the finger nail, Can be caused by cyanotic congenital heart disease, chronic suppurative lung disease, inflammatory bowel disease.

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What is koilonychia?

Spooning of the finger nails caused by iron deficiency anaemia

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What is palmar erythema?

Redness of the palms caused by raised oestrogen secondary to hepatic failure

In paediatric cve what do you check in pulses for?

Radial pulse rate and rhythm (do breathing rate same time)
Radio-radial delay 
Offer radio-femoral delay
Collapsing pulse
Offer Blood pressure
Carotid pulse

What is radio-radial delay?

Delay or absence of the radial pulse can be seen in coarctation of the aorta or aortic dissection. Absence of femoral also seen in coarctation

How to check collapsing pulse?

Raising the patient’s arm quickly to shoulder height (check for any pain first) while holding the lower arm
If present it will feel like a tapping impulse radiating through the forearm musculature

What is present collapsing pulse an indication of?

aortic regurgitation or a patent  ductus arteriosus

What to look for when palpating carotid pulses?

Low volume seen in aortic stenosis or circulatory insufficiency
High volume seen in anaemia or if the child is stressed
Pulsus parodoxus (pulse weakens on inspiration) can be seen in cardiac tamponade or constrictive  pericarditis
Exaggerated carotid pulsations can be seen in aortic  regurgitation (Corrigan’s Sign)

Paeds CVE what do you check face for?

Eyes: conjunctival pallor (anaemia), jaundiced sclera (CHF with hepatic congestion)
Cheeks: mitral flush (increased haematocrit in cyanotic heart disease)
Mouth: central cyanosis, dentition, high arched palate (Marfans)

Paeds resp exam, what do you check face for?

Eyes: conjunctival pallor
Mouth: central cyanosis, hydration status

Paeds Abdo exam, what do you check face for?

Eyes: jaundice, conjunctival pallor, Kayser-Fleischer rings (copper deposition secondary to hepatic disease)
Mouth: ulceration (crohn’s), central cyanosis, halitosis

Paeds CVE, what to look for in chest inspection?

``` Ask patient to put hands on hips. Operative scars Respiratory distress Precordial bulge (cardiac enlargement) Ventricular impulse (hyper-dynamic circulation or left ventricular hypertrophy but is normal in thin children ```

In paeds resp exam what to look for in chest inspection?

``` Hands on hips! Operative scars Respiratory hard work Central lines or ports Changes in chest shape or chest wall deformities: Hyper-expanded barrel shaped chest (poorly  controlled asthma), Pectus excavatum, Pectus carinatum, Harrison’s sulcus (poorly controlled asthma) Spinal curvatures - scoliosis, kyphosis Asymmetry of movement ```

Paeds Abdo exam what to look for on close inspection of abdomen?

Distention, movement with respiration, Operative scars

Paeds CVE what do you palpate for?

Apex beat- count ribs (between 4th and 5th) Thrills and heaves along sternal, border and suprasternal notch. Sign of ventricular hypertrophy. Offer to palpate liver at the end

How do you check for thrills and heaves?

Thrills: place hand over 4 valve areas of the heart- feels like cat purring (grade 4 murmurs) Heaves: place heel of hand on left sternal edge- feels like hand being lifted off chest wall with each systole (ventricular hypertrophy)

CVE what do you perform auscultation for?

``` SIMULTANEOUSLY PALPATE COROTID Apex Lower left sternal edge 2nd inter coastal space left sternal edge 2nd intercostal space right sternal edge Apex with bell roll on side hold breath. Below left clavicle ( patent ductus arteriosus) Left inter-scapular region (coarctation) Lung bases ```

In paeds resp exam, what do you palpate for?

Chest expansion, apex beat (count ribs) offer to check for tracheal deviation

In paeds abdominal exam what do you palpate?

Light and deep palpation of all 9 quadrants, start at site furthest away from pain. Palpate liver, spleen and kidneys

In paeds Abdo exam what do you percuss?

Liver, spleen and shifting dullness ( if there’s distention)

In paeds Abdo exam what do you auscultate?

Bowel sounds and renal artery bruits

In paeds resp exam what do you percuss?

All lung zones, listen for: Localised dullness (collapse, consolidation or fluid) Hyper-resonance (bronchiolitis, severe asthma or  pneumothorax)

In paeds resp exam what do you auscultate?

All lung zones including axillae. Listen for the quality and symmetry of breath sounds, paying particular attention to added sounds such as: Stridor - a low pitched inspiratory sound indicative of upper airway obstruction, such as in croup Wheeze - a high pitched expiratory sound indicative of distal airway obstruction, such as in asthma Crackles - moist sounds from the opening of  bronchioles, such as in pneumonia