OSCE for Abd, C spine, L spine

Question 1

what is the joint between vertebral articular processes?

Answer 1

zygapophyseal joint “facet”

Question 2

what does an increased jugular venous pressure indicate?

Answer 2

right sided heart failure

Question 3

what does a non midline trachea indicate?

Answer 3

tension pneumothorax

Question 4

what can be observed doing thyroid palpation?

Answer 4

goiter, tenderness

Question 5

what does a positive c spine compression/spurlings maneuver test indicate?

Answer 5

central neuropathy

Question 6

what does a neck distraction test indicated?

Answer 6

central neuropathy

Question 7

what does a positive valsalva test indicate?

Answer 7

+ is when sx are reproduced with valsalva

indicates space occypying lesion in cervical canal

Question 8

what is a positive Roos/east test and what does it indicate?

Answer 8

+ reproduction of sx

thoracic outlet due to subclavian compresion

Question 9

what does a positive adson test indicate?

Answer 9

+ loss or change in pulse
when looking away=thoracic outlet due to scalenes
when looking towards=thoracic outlet due to 1st rib

Question 10

what does wrights hyperabduction test indicate?

Answer 10

+ loss or change in pulse

indicates thoracic outlet syndrome via pec minor

Question 11

what does a costoclavicular/halstead test indicate?

Answer 11

+ loss or change in pulse

thoracic outlet due to 1st rib

Question 12

what does a kerning sign (nuchal rigidity) indicate?

Answer 12

+neck stiffness

indicates meningitis

Question 13

what does a brudzinski sign indicate?

Answer 13

+flexion in both hips and knees

indicates meningitis

Question 14

what does a kernig sign indicate?

Answer 14

+ increased resistance to hip flexion and pain behind knee

indicates dural irritation

Question 15

what is a jefferson fracture? cuase?

Answer 15

C1 compression fracture

head on hit like football

Question 16

what is a wedge fracture?

Answer 16

flexion and compression injury of c spine

Question 17

what is a dens fracture?

Answer 17

C2 odontoid process fracture needs surgury

Question 18

what is a hangmans fracture?

Answer 18

hyperextension C2 bilateral arch fracture

Question 19

spinous process fracture?

Answer 19

hyperextension or avulsion force from muscle contraction

Question 20

what is clay shovelers fracture?

Answer 20

C6 or C7 fracture

Question 21

whaat is a teardrop fracture?

Answer 21

flexion/compression injury –> anterior/inferior teardrop fragment

Question 22

what is a burst fracture?

Answer 22

idk

Question 23

what causes anterior subluxation?

Answer 23

facet dislocation without fracture

Question 24

what is the order of an abdominal exam?

Answer 24

inspect, auscultate, percuss, palpate

Question 25

what is cullens sign?

Answer 25

eccymosis around the umbilicus indicating hemmorhage

Question 26

what is grey turners sign?

Answer 26

flank ecchymosis secondary to hemmorhage

Question 27

what are normal bowel sounds? abnormal?

Answer 27

5-34 clicks, high pitched, decreased, absent

Question 28

what sound do you want to hear upon percussion of the abdomen? when will you hear dullness?

Answer 28

tympani over the liver and spleen

Question 29

where do you percuss the liver?

Answer 29

6-12 cm down at the mid clavicular line on the right

Question 30

where do you percuss the spleen?

Answer 30

ribs 6-10, mid axillary line on left

Question 31

how do you want to palpate the abdomen?

Answer 31

light 1cm then moderate 2-3cm then deep 3 cm. all in all 4 quadrants

Question 32

what is rebound tenderness? what does it indicate?

Answer 32

pain upon removal of pressure rather than the application of pressure peritonitis

Question 33

where is mcburneys point and what does tenderness here indicate?

Answer 33

1/3 distance between ASIS and umbilicis | +pain indicates appendicitis

Question 34

what does rosvigs sign indicate?

Answer 34

appendicitis

Question 35

what does a positive iliopsoas test indicate?

Answer 35

indicates irritation of the psoas muscle from the appendix

Question 36

what does a positive obturator test indicate?

Answer 36

irritation of the obturator muscle from the appendix

Question 37

what does a positive heel strike indicate?

Answer 37

appendicitis or peritonitis

Question 38

how do you palpate the liver?

Answer 38

palpate liver edge during patient inhalation

Question 39

what does a positive murpheys sign indicate?

Answer 39

cholecystitis or cholelithiasis

Question 40

what is courvoisiers sign and what does it indicate?

Answer 40

enlarged non tender gallbladder, indicates pancreatic disease/cancer

Question 41

what does a positive lloyds punch indicate?

Answer 41

infection around kidney, pyelonephritis, kidney stone

Question 42

how do you palpate the aorta?

Answer 42

just above umbilicus, slightly left of midline, should be less than 3cm

Question 43

where do lumbar roots exit the vertebra?

Answer 43

below whatever one theyre named for

Question 44

where does the spinal cord end?

Answer 44

L1-L3ish

Question 45

where does the cauda equina begin?

Answer 45

L2-L3

Question 46

what do you want to look for when observing a low back pain complaint?

Answer 46

slumped over, erect, assymetry, lordosis, gait changes

Question 47

what could a slumped over stance indicate?

Answer 47

depression, muscle spasm, reactive effort to relieve impinging lumbar nerves in intervertebral foramen

Question 48

what could an erect stance indicate?

Answer 48

protecting herniated discs or effects of spinal stenosis

Question 49

what could asymmetry indicate?

Answer 49

short leg, sacral base problem, scoliosis

Question 50

what could gait changes indicate?

Answer 50

listing-disc herniation, muscle weakness foot drop-fibular nerve injury shuffling-parkinsons

Question 51

what do you want to palpate when examining the low back? and what are you looking for at each landmark

Answer 51

spinous processes (step offs, fracture, dislocation, arthritis) SI joint- sacroiliitis, ankylosing spondylitis paravertebral muscles-MSK a normalities, strain, overuse, SD palpate area over symptoms-herniated disc may produce tenderness pretty much anywhere near it palpate for sciatic nerve tenderness-could indicate herniated disc or mass lesion palpate the skin

Question 52

what does the straight leg test tell you? (lasegue test)

Answer 52

+ test is worsening radicular pain at 30-60 degrees indicates lumbosacral radiculopathy (usually from herniated disc) + at >70 is more likely mechanical issue >15 could be IT band

Question 53

what are other signs or symptoms of radiculopathy?

Answer 53

muscle weakness and dermatomal sensory loss

Question 54

where do most disc herniations occur?

Answer 54

L5-S1

Question 55

what does the cross straight leg test tell you?

Answer 55

+ pain in the contralateral leg | indicates lumbosacral radiculopathy

Question 56

what does a positive hoovers sign indicate?

Answer 56

+ no downward force of unaffected leg when they "attempt" to life the affected leg indicates malingering

Question 57

what does a postive thomas test indicate?

Answer 57

iliopsoas contracture, causes a lot of LBP

Question 58

what does the gaenlen test indicate?

Answer 58

+ pelvic pain | SI joint dysfunction

Question 59

what can a valsalva test indicate?

Answer 59

+ reproduction of sciatic symptoms | indicates sciatica

Question 60

what can a stork test indicate?

Answer 60

+ low back pain | indicates pars defect/stress fracture

Question 61

what are symptoms of cauda equina syndrome? is this emergent?

Answer 61

yes its emergent low back pain, bowel/bladder dysfunction, sensory loss of perineum, bilateral sciatica

Question 62

what is spina bifida?

Answer 62

split in vertebrae with no spinal protrusion

Question 63

what is a meningocele?

Answer 63

meninges forced out between vertebrae

Question 64

what is a myelomeningocele?

Answer 64

spinal cord protrudes through opening

Question 65

what is fergusons angle? what is normal?

Answer 65

the angle between the planes of the most fucked up vertebrae in scoliosis i guess 30-40 degrees

Question 66

what is spondylosis?

Answer 66

degenerative change in vertebrae, osteoarthritis pretty much

Question 67

what is spondylolysis?

Answer 67

scotty dog pars interarticularis fracture of vertebrae

Question 68

what is spondylolisthesis?

Answer 68

anterior displacement of vertebrae