Spinal OSCE Exam

Question 1

What are the 5 things you should do as part of your introduction?

Answer 1

Wash hands
Introduce yourself
Confirm pt details
Explain examination
Gain consent

Question 2

How should you position the patient?

Answer 2

Expose pt’s upper body.

Position pt standing.

Question 3

What is the crucial question you should ask before starting the examination?

Answer 3

Ask if the pt currently has any pain.

Question 4

On first observation, what should you be looking for (around the bed)?

Answer 4

Aids & adaptations eg. walking stick, wheelchair

Question 5

Which angles should you inspect the pt from?

Answer 5

Front
Side
Behind

Question 6

Looking at the pt from the front, what 2 things are you assessing?

Answer 6

1. Posture of head & neck: symmetry / abnormal position

2. Symmetry of shoulders: note any misalignment

Question 7

Looking at the pt from the side, what 3 things are you assessing / looking for?

Answer 7

1. Cervical lordosis: assess for hyper-lordosis (spondylolisthesis / osteoporosis / discitis)
2. Thoracic kyphosis: normal is 20 - 45o. Hyperkyphosis >45o (? vertebral fracture)
3. Lumbar lordosis: assess for hyperlordosis (obesity / tight lower back muscles.

Question 8

Looking at the pt from behind, what 4 things are you looking for / assessing?

Answer 8

1. Scars: provide clues as to previous surgery / trauma
2. Wasting: paraspinal muscles / back muscles: may suggest chronic immobility
3. Scoliosis: lateral curvature of the spine - resembles an ‘S’ shape.
4. Abnormal hair growth: spina bifida

Question 9

What should you palpate to assess for ‘tenderness & alignment’?

Answer 9

Spinal processes & sacroiliac joints

Question 10

What should you palpate to identify any tenderness or muscle spasms?

Answer 10

Paraspinal muscles

Question 11

When palpating the spinal processes, sacroiliac joints & paraspinal muscles, where else should you be assessing?

Answer 11

The patient’s face as you palpate the areas - look for signs of pain / discomfort.

Question 12

What are the 4 active movements used to assess the cervical spine?

Answer 12

Flexion: touch your chin to your chest (Normal ROM = 0 - 80o)

Extension: look up at the ceiling (Normal ROM 0 - 50o)

Lateral flexion: Touch your ear to your shoulder (Normal ROM = 0 - 45o)

Rotation: Turn your head to the left and then to the right (Normal ROM 0 - 80o)

Question 13

What should you do if you find reduced ROM on active movement?
What should you assess for?

Answer 13

Perform passive movements.

Assess if pain / stiffness / muscle spasm is the restricting factor.

Question 14

What are the 3 active movements of the lumbar spine that you should assess?
How would you assess these?

Answer 14

Flexion: touch your toes, keeping your legs straight.

Extension: lead backwards as far as possible (Normal ROM = 10 - 20o)

Lateral flexion: slide your L hand down the outer aspect of your L leg as far as possible, keeping your legs straight. Repeat using R arm / R leg.

Question 15

What thoracic spine movement should you assess? How would you assess this?

Answer 15

Thoracic rotation:

Sit the pt down, with arms crossed across the chest & ask pt to turn side to side.

Question 16

Which 3 ‘special tests’ are used to assess the spine?

Answer 16

1. Schober’s test: tests the range of motion in the lumbar spine.
2. Sciatic stretch test (straight leg raise)
3. Femoral nerve stretch test.

Question 17

Which ‘special test’ assesses the range of motion in the lumbar spine?

Answer 17

Schober’s test

Question 18

How would you conduct a ‘Schober’s test’?

Answer 18

1. Identify the position of the posterior superior iliac spine (PSIS) - ‘dimples of Venus’
2. Mark the skin in the midline 5cm below PSIS.
3. Mark the skin 10cm above PSIS.
4. Ask pt to touch their toes (full lumbar flexion).
5. Measure the distance between 2 lines (started at 15cm).

Normally, the distance between the 2 marks should increase to >20cm.

Question 19

You find a reduced Range of motion on conducting the Schober’s test. What might this indicate?

Answer 19

Conditions such as Ankylosing spondylitis.

Question 20

Describe how you would conduct the ‘Sciatic stretch test’?

Answer 20

Straight leg raise.

1. Position pt supine on the bed.
2. Holding the ankle, raise the leg (passively flexing the hip) - keeping the knee straight
3. Normal ROM = 80-90o of passive hip flexion
4. Once the hip is flexed as far as the pt is able, dorsiflex the foot.

Question 21

What would you find if you had a ‘positive’ result from the Sciatic stretch test.

Answer 21

Patient experiences pain in the posterior or thigh / buttock.
If this causes pain in the lower back / thigh / buttocks, it suggests sciatic nerve root impingement.

Question 22

How would you conduct a ‘Femoral nerve stretch test’?

Answer 22

1. Position the patient prone
2. Flex the knee
3. Extend the hip
4. Plantar-flex the foot.

Question 23

Your patient has a positive ‘femoral nerve stretch test’. What will you observe?

Answer 23

Pain felt in the thigh / inguinal region.

Question 24

What 3 things should you do to complete the examination?

Answer 24

Thank patient
Wash hands
Summarise findings

Question 25

What further assessments / investigations may be required?

Answer 25

• Full neurovascular examination of all 4 limbs

- Perform further imaging if indicated: X-ray / CT / MRI