Flashcards in Spinal OSCE Exam Deck (25)
What are the 5 things you should do as part of your introduction?
Confirm pt details
How should you position the patient?
Expose pt's upper body.
Position pt standing.
What is the crucial question you should ask before starting the examination?
Ask if the pt currently has any pain.
On first observation, what should you be looking for (around the bed)?
Aids & adaptations eg. walking stick, wheelchair
Which angles should you inspect the pt from?
Looking at the pt from the front, what 2 things are you assessing?
1. Posture of head & neck: symmetry / abnormal position
2. Symmetry of shoulders: note any misalignment
Looking at the pt from the side, what 3 things are you assessing / looking for?
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.
Looking at the pt from behind, what 4 things are you looking for / assessing?
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
What should you palpate to assess for 'tenderness & alignment'?
Spinal processes & sacroiliac joints
What should you palpate to identify any tenderness or muscle spasms?
When palpating the spinal processes, sacroiliac joints & paraspinal muscles, where else should you be assessing?
The patient's face as you palpate the areas - look for signs of pain / discomfort.
What are the 4 active movements used to assess the cervical spine?
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)
What should you do if you find reduced ROM on active movement?
What should you assess for?
Perform passive movements.
Assess if pain / stiffness / muscle spasm is the restricting factor.
What are the 3 active movements of the lumbar spine that you should assess?
How would you assess these?
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.
What thoracic spine movement should you assess? How would you assess this?
Sit the pt down, with arms crossed across the chest & ask pt to turn side to side.
Which 3 'special tests' are used to assess the spine?
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.
Which 'special test' assesses the range of motion in the lumbar spine?
How would you conduct a 'Schober's test'?
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.
You find a reduced Range of motion on conducting the Schober's test. What might this indicate?
Conditions such as Ankylosing spondylitis.
Describe how you would conduct the 'Sciatic stretch test'?
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.
What would you find if you had a 'positive' result from the Sciatic stretch test.
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.
How would you conduct a 'Femoral nerve stretch test'?
1. Position the patient prone
2. Flex the knee
3. Extend the hip
4. Plantar-flex the foot.
Your patient has a positive 'femoral nerve stretch test'. What will you observe?
Pain felt in the thigh / inguinal region.
What 3 things should you do to complete the examination?