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OSCE > Examination > Flashcards

Examination Flashcards

1
Q

standard examination order

A

inspection > palpation > percussion > auscultation

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2
Q

neurological limb examination order

A

inspect > tone > power > reflexes > co-ordination > sensation

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3
Q

MSK examination order

A

look > feel > move > function

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4
Q

Cardiac examination

A
  1. introduction and consent, patient at 45o
  2. inspection of patient and bedspace
  3. hands - inspection, temp, CRT, cyanosis, clubbing, splinter haemorrhages
  4. arms - radial pulse, RR delay, RB delay, collapsing pulse, BP
  5. head - face, eyes, mouth
  6. neck - JVP, palpate and auscultate carotids
  7. chest - inspection, palpation (apex beat, heaves and thrills), auscultation (valves + roll/expiration (MS) + sit forward/3rd intercostal space/expiration (AR))
  8. lung bases and peripheral oedema
  9. To complete I would check the femoral pulses, BP in both arms + lying and standing, perform ophthalmoscopy and do a 12 lead ECG
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5
Q

Resp examination

A
  1. intro, 45o
  2. inspection of patient, bedspace, noises
  3. hands - fine tremor, asterixis, CRT, tar staining, clubbing, wating
  4. pulse and resp rate
  5. head - face, eyes, mouth
  6. neck - JVP, tracheal deviation, crichosternal distance/tracheal tug
  7. chest - inspection, palpation (expansion, apex beat), percussion, auscultation + vocal resonance
  8. repeat on back
  9. cervical lymph nodes, legs (pitting oedema, calf tenderness)
  10. to complete I would assess peak flow, check sputum and do a cardiac examination
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6
Q

peripheral arterial examination

A
  1. into, lie flat
  2. general inspection
  3. upper limbs - inspection, temp, CRT, radial pulse, brachial pulse, rr delay, rf delay, BP in both arms, allens test
  4. face - inspect
  5. neck - carotid pulse palpation and auscultation
  6. abdomen - inspect, palpate/auscultate aortic and femoral pulse
  7. lower limbs (standing then lying)- inspection, palpation (temp, CRT, all pulses, squeeze calf, peripheral sensation)
  8. Buerger’s angle - lift leg to 45o, hold 1m, sit up and hang legs off bed, watch feet for reactive hyperaemia
  9. ankle-brachial pressure index (divide highest systolic bp in legs by highest in arms <0.8 abnormal)
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7
Q

DVT examination

A
  1. intro
  2. general inspection
  3. leg inspection standing (skin, swelling, venous insufficiency signs, varicose veins)
  4. palpation lying - temp, tenderness, oedema, calf diameters, palpate pulses
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8
Q

varicose vein focussed examination

A
  1. intro
  2. general inspection
  3. inspect standing then lying - skin, swelling, signs of venous insufficiency, varicose veins (distribution, colour, prominence)
  4. palpation - varicosities (tenderness, hardness), saphenofemoral junction (4cm lateral and inferior to pubic tubercle) +cough test +tap test, elevate limb to 15o +note rate of venous emptying, calf tenderness, arterial pulses, pitting oedema
  5. trendelenburg/ tourniquet test - lift leg high, milk veins, apply tourniquet on sfj, stand, rapid refilling = incompetent valve below tourniquet = repeat moving tourniquet down 3cm each time NOT REQUIRED FOR OSCE
  6. auscultate - machinery murmur = av fistula
  7. examine abdo
  8. to complete - perthes test, auscultate using doppler
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9
Q

Abdo examination

A
  1. intro + lie flat
  2. general inspection
  3. hands - inspect, asterixis, temp, clubbing, nails, dupuytren’s contracture, pulse
  4. face - inspect eyes and mouth
  5. palpate for cervical lymphadenopathy
  6. inspect chest and back and abdo
  7. palpation - superficial, deep, liver, spleen, kidney, aorta, bladder
  8. percussion - liver, spleen, flank (if dull then test shifting dullness/fluid thrill)
  9. auscultation - RLQ, aortic bruit, renal bruits
  10. pitting oedema
  11. to complete - ISHRUG (inguinal lymph nodes, stools, hernial orifices, rectal examination, urinalysis, genitalia)
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10
Q

DRE

A
  1. intro, consent, chaperone
  2. equipment - lubricant, gauze, paper towels, gloves/apron
  3. inspection - part buttocks, patient bear down to look for prolapses
  4. lubricate finger and place on anus until sphincter relaxes then advance finger (feel for faeces, and masses, bear down, squeeze finger, 360 sweep, feel prostate)
  5. remove finger and wipe on gauze (look for blood, mucus etc)
  6. clean anus and restore clothes
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11
Q

Upper limb neuro examination

A
  1. intro + ask if any pain, let or right handed
  2. inspect for posture, wasting, tremor, fasciculations, involuntary movements, pronator drift
  3. Tone - passively move each joint (spasticity is velocity dependant, ridgidity is constant) - hypertonia/hypo
  4. Power against resistance - chicken, boxer, biker, hitchhiker, finger abduction, squeeze fingers
  5. reflexes - bicep, tricep, supinator
  6. co-ordination - finger to nose with eyes closed, finger-finger-nose, thumb to fingertips, dysdiadochokinesis
  7. sensation - soft touch, proprioception, vibration
  8. To complete I would like to test temperature and pinprick sensation
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12
Q

Lower limb neuro examination

A
  1. intro, consent, any pain?
  2. Inspection
  3. Rombergs test - feet together arms out then eyes closed (failed eyes open = cerebellar, failed eyes closed = loss of proprioception)
  4. Gait - walk and heel-to-toe
  5. tone, ankle clonus
  6. power - leg up/down, out/in, knee out/in, ankle up/down, big toe up/down
  7. reflexes - knee, ankle, plantar reflex
  8. co-ordination - heel-shin test
  9. soft touch, proprioception, vibration
  10. to complete the examination I would test pain and temperature sensation
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13
Q

MRC grading of motor power

A

5/5 - full power against resistance
4/5 - movement against gravity, reduced against resistance (grades 4-, 4, 4+)
3/5 - against gravity but not against resistance
2/5 - movement when gravity removed
1/5 - muscle contraction with no movement
0/5 - no contraction

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14
Q

Mental state examination

A
  1. appearance - clothing, hygiene, posture, eye contact, level of arousal
  2. speech - rate, rhyme, tone, volume
  3. mood and affect - nature, severity, variability, congruent/incongruent affect
  4. thoughts - stream, form, delusions
  5. perception - dissociative symptoms, illusions, hallucinations (auditory, visual, tactile, gustatory/olfactory)
  6. cognition - orientation to time and place, memory functioning, attention and concentration
  7. Insight - awareness and understanding
  8. RISK assess - thoughts of self harm, suicide, harming others
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15
Q

Cranial nerve examination

A
  1. intro, consent, general inspection
  2. olfactory (I) - any changes in smell
  3. optic (II) - acuity (snellen chart/ count fingers), fields (cover one eye and test 4 quadrants), inattention (which finger is moving), reflexes
  4. oculomotor (III), trochlear (IV), abducens (VI) - H and I (any double vision)
  5. trigeminal (V) - sensation, motor (clench teeth and feel for contraction), open mouth against resistance, jaw jerk
  6. facial (VII) - close eyes, raise eyebrows, puff out cheeks, purse lips and show teeth
  7. vestibulocochlear (VIII) - whisper number, rinnes and webers if abnormality suspected
  8. glossopharyngeal (IX), vagus (X) - open mouth ‘ahh’, swallow, cough, any hoarsness
  9. accessory (XI) - shrug shoulders, turn head against resistance
  10. hypoglossal (XII) - open mouth (fasciculations), stick out, push into cheeks
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16
Q

Cerebellar examination

A
  1. nystagmus - H and I movements
  2. speech - british constitution, baby hippopotamus
  3. intention tremor and dysmetria (finer to nose))
  4. dysdiadochokinesia
  5. stance - observe for wide base
  6. ataxia - stand eyes closed and feet together
  7. gait - walk and heel-to-toe
17
Q

hernia examination

A
  1. intro, consent, check no pain
  2. inspect groin for swelling while standing then when coughing
  3. feel hernia while coughing
  4. examine scrotum
  5. lie flat and feel relationship of swelling to pubic tubercle
  6. attempt to reduce the hernia by gentle sustained pressure
18
Q

4 parts of testicular examination

A
  1. can you get above it
  2. can the testis and epididymis be identified seperately
  3. does the swelling transilluminate
  4. is the swelling tender
19
Q

GALS screening test

A
  1. intro etc
  2. initial questions (any pain or stiffness, can you dress ad undress, can you go up and down stairs)
  3. inspection (from front, side, back)
  4. gait - walk up and down (comment on pain, arm swing, pelvic tilt, stride length)
  5. spine - lumbar spine flexion (two fingers on vertebrae then bend forward), lateral flexion of neck (ear to shoulder)
  6. arms - hands behind head and push elbows back,
  7. wrists and hands - look (hands out, arms straight, turn hands over), squeeze MCP joints, make a fist, squeeze my fingers, each finger to thumb
  8. legs - lie down with legs out, patellar tap, flex and extend knee actively with my hand over knee, bend hip and knee then I will use ankle to test internal and external rotation
  9. feet - inspect soles, squeeze across MTP joints
20
Q

Hip examination

A
  1. intro etc
  2. inspection - standing from front/side/back, assess gait, lying for scars etc, leg length (apparent = xiphisternum to medial malleolus, true= from ASIS)
  3. palpation - any pain? temp, palpate greater trochanter
  4. move - active range of motion then passive (flexion, abduction, adduction), passive ROM of internal and external rotation
  5. special tests - Thomas’s test for fixed flexion deformity (hand under spine and then flex other leg), Trendelenburg’s test for abductor muscle strength (stand on one leg and look for pelvis dip)
  6. to complete - examine lumbar spine and knees, perform a neurological and vascular examination
21
Q

Knee examination

A
  1. intro and expose legs
  2. look - standing from front/side/back, walk (toeing angle), inspect lying down
  3. feel - temp, borders of patellar and behind knee, patellar tap and bulge test, flex knee and palpate joint line and tibial tuberosity
  4. move - active flexion and extension, passive ROM feeling knee for crepitus
  5. special tests - posterior sag (PCL damage), anterior draw (ACL damage), lateral and medial collateral ligament test
  6. to complete - examine hip and ankle, assess neurological and vascular status of limb
  7. may do McMurray’s test for torn miniscus if told to (flex hip and maximal knee flexion then internal/external rotation and extend knee slowly)
22
Q

ankle and foot examination

A
  1. look - shoes, while standing from front/side/back, look at arches, stand on tiptoes, assess walking
  2. feel - standing palpate achilles tendon, lie down and inspect all skin (inbetween toes too), temp, shafts of tibia/fibula, malleoli, palpate talus anterior to malleoli while inverting/everting foot, lateral squeeze of MTP joints
  3. move - active ROM (dorsiflexion, plantar flexion, inversion, eversion, big toe up and down), passive ROM
  4. to complete - examine knee, neuro and vascular exam.
23
Q

spine examination

A
  1. intro, consent, any pain?
  2. look- front/side/back, gait
  3. feel - whole spine and neck for tenderness, paraspinal muscles, supraclavicualr fossa, SI joints
  4. move - active ROM cervical (flexion, extension, lateral flexions, rotation), thoracic/lumbar (flexion/how close fingers to ground, Schnober’s test (measure 10cm above, 5cm below posterior superior iliac spines then bend forward and remeasure >5cm normal), extension, lateral flexion measuring distance of each hand to the floor (>10cm normal), seated rotation with arms folded, bend forward and percuss spine
  5. to complete - full upper/lower limb neuro examinations, vascular examinations, shoulders if neck pain
  6. special tests - straight leg raise for prolapsed disc (passively flex hip with leg straight), Bowstring test (straight leg raise then when pain flex knee and push poplitial fossa), femoral stretch test (prone then flex knee to stretch femoral nerve roots L2-4), chest expansion for ankylosing spondylitis
24
Q

shoulder examination

A
  1. intro, expose, any pain?, can they dress themselves and wash hair without difficulty?
  2. look - standing from front/side/back
  3. feel - temp, palpate joints and muscles from front to back (include scapula)
  4. move - screening (hands behind head and push back, how far can reach up back), active ROM (internal/external rotation, flexion and extension, abduction/painful arc observing from front and back), passive ROM while palpating for crepitus
  5. special test (told if need to do) - resisted active abduction, resisted active external rotation, resisted internal rotation (hand behind back and push off), acromio-clavicular joint pathology (scarf test - forced adduction across chest)
  6. to complete - examine cervical spine and elbow, neuro and vascular exam
    5.
25
Q

elbow examination

A
  1. look
  2. feel while flexed 90
  3. move - active/passive of flexion, extension, supination, pronation
  4. function - hand to nose
  5. special tests - assess medial epicondylitis/golfers elbow (arm supinated, flex fist/wrist against resistance), lateral epicondylitis/tennis elbow (pronated arm then extend wrist against resistance)
26
Q

hand examination

A
  1. intro, seated with hands on pillow, any pain or numbness?
  2. look - nails, dorsum, palm, elbows (psoriatic plaques)
  3. feel - temp, palpate starting from wrist down, MCPJ squeeze test, check sensation, ulnar and radial pulses, allen’s test
  4. move - active then passive (finger flexion(fist)/extension/abduction/adduction, thumb flexion/extension/palmar abduction/palmar adduction/opposition, wrist prayer/reverse prayer, radial and ulnar deviation)
  5. function - power grip (squeeze pen/fingers), lateral pinch grip (hold a key or pen normally), precision grip (do/undo buttons/pick up penny)
  6. special test for carpal tunnel syndrome (median nerve) - light touch in nerve distribution, thumb palmar abduction against resistance, tinels test (tap median nevrve), phalen’s test (hold hands in reverse prayer for 1m), compression of carpal tunnel test
  7. special test for ulnar nerve - sensation, cross index and middle finger, grip paper using finger and thumb without bending thumb, abduct fingers against resistance
  8. special test radial nerve - sensation in anatomical snuff box, wrist and finger dorsiflexion against resistance
27
Q

thyroid examination

A
  1. intro, consent, seated in chair, listen for hoarse voice
  2. inspection - general, hands (temp, sweating, clubbing etc), tremor (piece of paper on hands), pulse, muscle wasting, eyes (inspect from side for exophthalmos/lid retraction, lid lag (look up then down), eye movements (H &I), visual acuity), inspect neck, water swallow test, protrude tongue, inspect back of tongue for lingual thyroid
  3. palpation - trachea, feel any mass from behind (describe, mobility, surrounding tissue, swallow movement, tongue out), lymph nodes
  4. auscultation - hold breath andd listen over both sides with bell
  5. check proximal muscle weakness by standing up with arms crossed, ankle reflexes, inspect for pretibial myxoedema
28
Q

breast examination

A
  1. intro, consent, chaperone
  2. inspection - seated on edge of couch look for abnormalities in the contours of each breast and for visable masses, skin changes, nipple retraction etc, hands behind head and push elbows back, hands on hip and push inwards
  3. palpation - lie at 45o, palpate 4 quadrants + axillary tail + nipple, axillary (support arm to relax muscles) and supraclavicular lymph nodes, palpate and percuss abdo/vertebrae if indicated
29
Q

diabetic foot examination

A
  1. intro, consent, any pain
  2. inspection - gait, shoes, skin on feet and lower legs including between toes and heel, look at arch
  3. palpation - bones and joints of ankle/foot for swelling/tenderness
  4. vascular - temp, CRF, pulses (femoral (omit), popliteal, posterior tibial, dorsalis pedis)
  5. neuro - ankle reflexes, light touch, pressure (using monofilament to pulp of hallux, 1st/3rd/5th metatarsal heads), proprioception, vibration
  6. to complete i would test pin prick and temperature sensation and check the femoral pulses

OSCE (3 decks)

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