Exam practical skills

Question 1

MMSE

Answer 1

1. orientation in time and place
2. Registration: 3 objects (apple, table, penny): say will ask later
3. Spell ‘world’ backwards
4. Recall the objects
5. Name famous person (prime minister)

Question 2

Cranial nerves: interpretation of weber’s and rinne’s, how to test 9, 10?

Answer 2

Rinnes:
-Air conduction louder: either normal, or sensorineural
-Bone conduction louder: conductive hearing loss

Weber’s:
-Same both ears: normal
-More in affected ear: conductive
-More in other ear: sensorineural

9: +10
–> Open mouth and say ‘ah’ (looking for deviation uvula/soft palate)
–> ask pt to cough (assess adduction of both vocal cords by vagus nerve
–> gag reflex (not done)

Question 3

Ankle examination

Answer 3

Look
–> gait

Feel:
–> proximal fibula

Move
–> do movements actively and passively (plantarflexion, dorsiflexion, inversion, eversion)

Special tests
–> Simmonds test
–> anterior drawer test
–> Talar tilt test: inversion in dorsilexion, plantarflexion and anatomical position
–> Eversion in anatomical position

Question 4

Inguinal hernia

Answer 4

Inspection
–> ask about pain
–> ask pt to cough

Palpation
–> Check for temperature
–> identify asis, pubic tubercle: show position of lump in relation to inguinal ligament
–> examine scrotum including scrotal neck
–> palpate in groin for lymph nodes

Auscultate

Tests
-Deep inguinal ring test
-Transillumination

Question 5

Varicose veins

Answer 5

Inspection
–> ask pt to turn around

Palpatino
–> Feel for saphena varix: ask pt to cough if present will have thrill

Special tests
–> trendelenburg test
–> perthes test
–> hand held doppler assessment

To complete exam: examine arterial system and the abdomen

Question 6

Submandibular examination

Answer 6

Inspection
–> marginal mandibular nerve: show me your teeth
–> hypoglossal nerve: stick out your tongue

Palpation
–> lingual nerve

Ix:
-US/FNA if malignancy suspected
-Sialogram if salivary stone suspected
-CT

Mx
Conservative: analgesia, abx, hydration, gland massage. Sialogram can occasionally be therapeutic

duct can be laid open and stone retrieved if intraductal and duct is left open to avoid stricture
Sialendoscopy: stone retrieval via endoscopic technique