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2b Content OSCE Stan > Examinations > Flashcards

Examinations Flashcards

1
Q

Introduction to any examination

A
  • Wash hands
  • Introduce yourself
  • Confirm patient’s name + DOB
  • Explain exam + gain consent
  • Any pain?
    - Which side (if relevant)?
  • Chaperone?
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2
Q

Cardiac examination - general structure

A
  • Intro
  • General inspection
  • Hands
  • Pulses
  • Face
  • Neck
    …
  • Inspect chest
  • Palpate chest
  • Auscultate chest
    …
  • Auscultate lung bases
  • Hepatomegaly
  • Oedema
    - Sacral
    - Pedal
    …
  • Thank patient
  • Present exam
  • To complete…
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3
Q

Cardiac exam - hands

A
  • General
  • CRT
  • Nails
    - Clubbing
  • Temperature
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4
Q

Cardiac exam - pulses

A
  • Radial on one side
    - Time
    - Also assess RR
  • Radial on both sides
  • Collapsing pulse
  • Brachial pulse
    …
  • Auscultate carotids first
  • 2x carotid pulses
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5
Q

Cardiac exam - face

A
  • General
  • Eyes
  • Mouth
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6
Q

Cardiac exam - neck

A
  • JVP
    - Press on liver
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7
Q

Cardiac exam - initial chest

A
  • Inspect chest
  • Palpate chest
    - Count ribs for apex beat
    - Apex beat
    - Heaves
    - Thrills
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8
Q

Cardiac exam - auscultate chest

A
  • Palpate carotid pulse at the same time
    …
  • Diaphragm
    - 4 valve areas
  • Bell
    - 4 valve areas
  • Accentuation manoeuvres
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9
Q

Cardiac exam - auscultation manoeuvres

A
  1. Roll onto left side, auscultate mitral area with diaphragm, follow to axilla, expiration
  2. Still on left side, auscultate mitral area with bell, expiration
  3. Sit forwards, auscultate aortic area with diaphragm, expiration
  4. Auscultate carotid arteries with diaphragm, inspiration
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10
Q

Cardiac exam - final steps

A
  • Auscultate lung bases
  • Hepatomegally
  • Oedema
    - Sacral
    - Pedal
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11
Q

Presenting a cardiac exam

A
  • I performed a cardiac examination on ____ who is a ____ year old male/female
  • On general inspection, he/she appeared comfortable at rest
  • On closer inspection, there were no peripheral stigmata of cardiac pathology
  • The pulse was ___bpm and was of normal rhythm, volume and character
  • On palpation, there were no heaves and thrills and the apex beat was not displaced
  • On auscultation, 1st and 2nd heart sounds were present with no added sounds
  • In summary, this was a normal cardiac examination
  • TO COMPLETE MY EXAMINATION I WOULD…
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12
Q

How would you complete a cardiac examination?

A
  • 12 lead ECG
  • Lying and standing blood pressure
  • Fundoscopy
  • Femoral pulses
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13
Q

Resp examination - general structure

A
  • Intro
  • General inspection
  • Hands
  • Face
  • Neck
    …
  • Inspect chest
  • Palpate chest
  • Percuss chest
  • Auscultate chest
    …
  • Inspect back
  • Palpate back
  • Percuss back
  • Auscultate back
    …
  • Oedema
    - Sacral
    - Pedal
  • Squeeze calves
    …
  • Thank patient
  • Present exam
  • To complete…
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14
Q

Resp exam - hands

A
  • General
  • CRT
  • Nails
    - Clubbing
  • Temperature
  • Tremor
    - Fine
    - Flapping
  • Pulse + RR
  • Arms
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15
Q

Resp exam - face

A
  • General
  • Eyes
  • Mouth
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16
Q

Resp exam - neck

A
  • Lymph nodes
  • Palpate trachea
  • Cricosternal distance
  • JVP
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17
Q

Resp exam - chest

A
  • Inspection
  • Palpation
    - Count ribs
    - Apex beat
    - Chest expansion
    - Vocal fremitus
  • Percussion
  • Auscultation
    - Vocal resonance
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18
Q

Resp exam - back

A
  • Inspection
  • Palpation
    - Chest expansion
    - Vocal fremitus
  • Percussion
  • Auscultation
    - Vocal resonance
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19
Q

Resp exam - final steps

A
  • Oedema
    - Sacral
    - Pedal
  • Squeeze calves
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20
Q

Presenting a resp exam

A
  • I performed a respiratory examination on ___ , a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest with non-laboured breathing
  • On closer inspection, there were no peripheral stigmata of respiratory disease
  • The patient had a pulse of ___bpm and the respiratory rate was _____
  • On palpation, the patient had normal and symmetrical chest expansion bilaterally
  • On percussion, all lung fields were resonant
  • On auscultation, vesicular breath sounds were present with no added sounds
  • In summary, this was a normal respiratory examination
  • TO COMPLETE MY EXAMINATION I WOULD…
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21
Q

How would you complete a resp examination?

A
  • Sputum sample
  • Peak flow/spirometry
  • O2 sats + BP
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22
Q

Abdo examination - general structure

A
  • Intro
  • General inspection
  • Hands
  • Face
  • Neck
    …
  • Inspect abdomen
  • Palpate abdomen
    - Organs
  • Percuss abdomen
    - Organs
  • Auscultate abdomen
    - Bowel sounds
    - Bruits
    …
  • Oedema
    - Sacral
    - Pedal
    …
  • Thank patient
  • Present exam
  • To complete…
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23
Q

Abdo exam - hands

A
  • General
  • CRT
  • Nails
    - Clubbing
  • Temperature
  • Tremor
    - Flapping
  • Pulse + RR
  • Arms
  • Axillae
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24
Q

Abdo exam - face

A
  • General
  • Eyes
  • Mouth
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25
Q

Abdo exam - neck

A
  • Lymph nodes
  • JVP
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26
Q

Abdo exam - palpate abdomen

A
  • Superficial palpation - 9 areas
  • Deep palpation - 9 areas
  • Organs
    - Liver
    - Murphy’s sign
    - Spleen
    - Ballot kidneys
    - Bladder
  • Palpate aorta
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27
Q

Abdo exam - percuss abdomen

A
  • Liver
  • Spleen
  • Bladder
    (* Shifting dullness)
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28
Q

Abdo exam - auscultate abdomen

A
  • Bowel sounds
  • Bruits
    - Aortic
    - Renal
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29
Q

Abdo exam - final steps

A
  • Oedema
    - Sacral
    - Pedal
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30
Q

Presenting an abdo exam

A
  • I performed an abdominal examination on ___ , a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest
  • On closer inspection, there were no peripheral stigmata of gastrointestinal disease
  • On palpation the abdomen was soft and non-tender and there was no evidence of organomegaly
  • On auscultation, bowel sounds were present and normal, there were no bruits heard
  • In summary, this was a normal abdominal examination
  • TO COMPLETE MY EXAMINATION I WOULD…
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31
Q

How would you complete an abdo examination?

A

I - Inguinal lymph nodes
S - Stool sample
H - Hernial orifices (femoral and inguinal)
R - Rectal examination
U - Urine analysis
G - Genitalia

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32
Q

Thyroid examination - general structure

A
  • Intro
  • General inspection
  • Hands
  • Eyes
  • Thyroid gland
  • Other neck features
  • Distal features
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33
Q

Thyroid exam - hands

A
  • General
  • CRT
  • Nails
    - Clubbing
  • Temperature
  • Tremor
  • Pulse
  • Arms
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34
Q

Thyroid exam - eyes

A
  • General inspection of face
    …
  • Inspect eyes
  • Look from side
  • Look from behind
    …
  • Eye movements
  • Lid lag
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35
Q

Thyroid exam - thyroid gland

A
  • Inspect thyroid from front
    - Swallow
    - Stick out tongue
    …
  • Palpate thyroid from back
    - Swallow
    - Stick out tongue
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36
Q

Thyroid exam - other neck features

A
  • Lymph nodes
  • Tracheal deviation
  • Percuss sternum
  • Auscultate for bruits
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37
Q

Thyroid exam - distal features

A
  • Ankle reflexes
  • Inspect for pretibial myxoedema
  • Stand up with arms crossed
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38
Q

Presenting a thyroid exam

A
  • I performed a thyroid examination on ___ who is a ___ year old male/female
  • On general inspection, he/she appeared well at rest
  • On closer inspection, there were no peripheral stigmata of thyroid pathology including thyroid masses or eye disease
  • The pulse was of normal rate and rhythm at ___bpm
  • On palpation, the trachea was not deviated and there was no evidence thyroid mass or swelling
  • On percussion, there was no evidence of retrosternal goitre
  • On auscultation, there was no evidence of bruits or heart murmur
  • Finally, there was no muscle weakness, pretibial myxoedema, and reflexes appeared normal bilaterally.
  • In summary, this was a normal thyroid examination
  • TO COMPLETE MY EXAMINATION I WOULD…
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39
Q

How would you complete a thyroid examination?

A
  • Fundoscopy
  • Visual acuity
  • TFT blood tests
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40
Q

Upper limb neuro examination - general structure

A
  • Intro
    - Ask handedness
  • General inspection
  • Pronator drift
    …
  • Tone
  • Power
  • Reflexes
  • Coordination
  • Sensation
    …
  • Thank patient
  • Present exam
  • To complete…
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41
Q

Upper limb neuro exam - what’s an important question to ask at the beginning?

A

Are you left or right handed?

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42
Q

Upper limb neuro exam - ‘special test’

A
  • Pronator drift
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43
Q

Upper limb neuro exam - tone

A
  • Passively move each arm to assess tone
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44
Q

Upper limb neuro exam - power

A

Assess each side separately, isolate each joint
* Shoulders
* Elbows
* Wrists
* Fingers
* Thumbs

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45
Q

Upper limb neuro exam - reflexes

A
  • Biceps
  • Triceps
  • Brachioradialis

Use reinforcement if needed

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46
Q

Upper limb neuro exam - coordination

A
  • Dysdiadochokinesia
  • Finger to nose with eyes closed
  • Finger back and forth between nose and examiner’s finger
  • Fingers to thumb in sequence
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47
Q

Upper limb neuro exam - sensation

A
  • Light touch
    …
  • Vibration
  • Proprioception
    …
    (* Stereognosis - identify object in palm)
    (* Two point discrimination)
    (* Graphaesthesia - draw number on palm)
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48
Q

Presenting an upper limb neuro exam

A
  • I performed an upper limb neurological examination on ___ who is a ___ year old
    male/female
  • On general inspection, he/she appeared well at rest
  • There were no abnormalities in posture, deformities, muscle wasting, or fasciculation’s detected, Pronator drift was -ve
  • Tone was normal throughout
  • Power was 5/5 in all muscle groups bilaterally
  • Reflexes were normal bilaterally
  • Coordination was intact
  • Sensation was normal in all modalities tested
  • In summary, this was a normal upper limb neurological examination
  • TO COMPLETE MY EXAMINATION I WOULD…
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49
Q

How would you complete an upper limb neuro exam?

A
  • Examine pin-point/pain and temperature sensation
  • Lower limb neuro, cranial nerve and cerebellar exams
  • Neuroimaging - MRI head + spine
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50
Q

Lower limb neuro examination - general structure

A
  • Intro
    - Ask handedness
  • General inspection
  • Gait
  • Romberg’s test
    …
  • Tone
  • Power
  • Reflexes
  • Coordination
  • Sensation
    …
  • Thank patient
  • Present exam
  • To complete…
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51
Q

Lower limb neuro exam - ‘special tests’

A
  • Gait
    - Normal
    - Heel-to-toe
  • Romberg’s test
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52
Q

Lower limb neuro exam - tone

A
  • Passively move + roll each leg to assess tone
  • Ankle clonus
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53
Q

Lower limb neuro exam - power

A
  • Hip (x4)
  • Knee
  • Ankle
  • Big toe
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54
Q

Lower limb neuro exam - reflexes

A
  • Patellar
  • Ankle jerk
  • Babinski
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55
Q

Lower limb neuro exam - coordination

A
  • Heel-to-shin test
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56
Q

Lower limb neuro exam - sensation

A
  • Light touch
    …
  • Vibration
  • Proprioception
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57
Q

Presenting a lower limb neuro exam

A
  • I performed a lower limb neurological examination on ___ a ___ year old male/female
  • On general inspection, he/she appeared well at rest and gait appeared normal, Rombergs test was -ve
  • On closer inspection, there were no abnormalities in posture, deformities, muscle wasting or fasciculation’s detected
  • Tone was normal throughout
  • Power was 5/5 in all muscle groups bilaterally
  • All reflexes were normal bilaterally
  • Coordination was intact
  • Sensation was normal in all modalities tested
  • In summary, this was a normal lower limb neurological examination
  • TO COMPLETE MY EXAMINATION I WOULD…
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58
Q

How would you complete a lower limb neuro exam?

A
  • Examine pin-point/pain and temperature sensation
  • Upper limb neuro, cranial nerve and cerebellar exams
  • Neuroimaging - MRI head + spine
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59
Q

Cranial nerve exam - general structure

A
  • Intro
  • General inspection
  • Ask about smell (CN1)
    …
  • Visual tests (CN2)
  • Eye movement tests (CN 3,4,6)
    …
  • Face sensation (CN5)
  • Muscles of mastication (CN5)
  • Facial movements (CN7)
    …
  • Hearing (CN8)
  • Weber’s + Rinne’s tests (CN8)
  • Vestibular function (CN8)
    …
  • Assess throat (CN9,10)
  • Swallow, cough (CN9,10)
  • Tongue (CN12)
    …
  • Turn head against resistance (CN11)
  • Raise shoulders against resistance (CN11)
    …
  • Thank patient
  • Present exam
  • To complete…
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60
Q

Cranial nerve exam - visual tests (CN2)

A
  • Inspect pupils
  • Visual acuity
    …
  • Visual fields
    (* Blind spot)
  • Visual inattention
    …
  • Direct + consensual pupillary reflex
  • Swinging light test
  • Accommodation reflex (distant –> nearby)
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61
Q

Cranial nerve exam - eye movement tests (CN3,4,6)

A
  • Follow finger - H + I
  • Ask if any double vision
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62
Q

Cranial nerve exam - CN5

A
  • Light touch - V1, V2, V3 areas
    …
  • Assess muscle bulk of muscles of mastication - teeth clenched
  • Open jaw against resistance
    …
  • Jaw jerk reflex
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63
Q

Cranial nerve exam - facial movements (CN7)

A
  • Screw up eyes
    - Against resistance
  • Puff out cheeks
    - Against resistance
  • Raise eyebrows
  • Purse lips
  • Show teeth
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64
Q

Cranial nerve exam - CN8

A
  • Assess hearing - whisper a number in each ear
  • Weber’s test
  • Rinne’s test
    …
  • Unterberg - march on spot, arms out, eyes closed
  • Vestibular-ocular reflex - focus on nose, head turned left and right, watch eyes
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65
Q

Cranial nerve exam - CN9+10

A
  • Open mouth wide + inspect
  • Say “aah”
  • Swallow
  • Cough
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66
Q

Cranial nerve exam - tongue (CN12)

A
  • Stick out tongue
  • Move from side to side
  • Push into cheek against resistance
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67
Q

Cranial nerve exam - CN11

A
  • Turn head against resistance (+ palpate sternomastoid muscle with free hand)
  • Raise shoulders against resistance
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68
Q

Presenting a cranial nerve exam

A
  • I performed a cranial nerve examination on ___ , a ___ year old male/female
  • On general inspection, he/she appeared well at rest
  • On examination of cranial nerves I-XII, there were no abnormalities detected
  • TO COMPLETE MY EXAMINATION I WOULD…
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69
Q

How would you complete a cranial nerve exam?

A
  • Upper limb neuro and lower limb neuro exams
  • Neuroimaging - MRI head
  • Formal hearing assessment
70
Q

Cerebellar examination - general structure

A
  • Intro
  • General inspection
  • Stance
  • Gait
  • Romberg’s test
    …
  • Speech + mouth
  • Eyes
    …
  • Arms
  • Legs
    …
  • Thank patient
  • Present exam
  • To complete…
71
Q

Cerebellar exam - standing up

A
  • Stance
  • Gait
    - Normal
    - Heel-to-toe
  • Romberg’s test
72
Q

Cerebellar exam - speech + mouth

A
  • Repeat “British constitution”
  • Repeat “baby hippopotamus”
    …
  • Move tongue side to side
73
Q

Cerebellar exam - eyes

A
  • Follow H + I
    - Observe for nystagmus
  • Look at hand and then nose, on each side
    - Observe for dysmetric saccades
74
Q

Cerebellar exam - upper limb

A
  • Tone
  • Dysdiadochokinesia
  • Finger-to-nose
  • Rebound phenomenon
  • Pronator drift
  • Intention tremor
75
Q

Cerebellar exam - lower limb

A
  • Tone
  • Heel-to-shin
  • Knee jerk reflex
76
Q

Presenting a cerebellar examination

77
Q

How would you complete a cerebellar exam?

A
  • Cranial nerves, upper limb neuro and lower limb neuro exams
  • Neuroimaging - MRI head
  • Formal hearing assessment
78
Q

Hand examination - general structure

A
  • Intro
    - Any pain?
    - Any numbness/tingling?
  • General inspection
    …
  • Look
  • Feel
  • Vascular
  • Sensory
  • Move
    - Active
    - Passive
  • Function
  • Special tests
    - Median nerve
    - Ulnar nerve
    - Radial nerve
    …
  • Thank patient
  • Present exam
  • To complete…
79
Q

Hand exam - look

A
  • Nails
    - Clubbing
  • Dorsum
  • Palms
  • Elbows
80
Q

Hand exam - feel

A
  • Temperature
    …
  • Palpate wrist
  • Palpate metacarpals
  • MCP joint squeeze
  • Palpate phalanges
81
Q

Hand exam - sensation

A

Dermatomes
* C6 - thumb tip
* C7 - middle finger tip
* C8 - little finger tip
…
Nerves
* Radial - dorsal side, first webspace (snuffbox)
* Median - palmar side, thenar eminence
* Ulnar - palmar side, hypothenar eminence

82
Q

Hand exam - vascular

A
  • Check radial + ulnar pulses
  • Allen’s test
83
Q

Hand exam - active movement

A

Fingers
* Make a fist
* Straighten fingers out again
* Spread fingers out + back in
…
Thumb
* Flexion + extension
* Abduction + adduction
* Opposition
…
Wrist
* Dorsiflexion + palmarflexion
* Wiggle hand side to side - radial/ulnar deviation

84
Q

Hand exam - passive movement

A

Fingers
* Make a fist
* Straighten fingers out again
* Spread fingers out + back in
…
Thumb
* Flexion + extension
* Abduction + adduction
* Opposition
…
Wrist
* Dorsiflexion + palmarflexion
* Wiggle hand side to side - radial/ulnar deviation

85
Q

Hand exam - function

A
  • Grip examiners finger, and resist them pulling it out
  • Hold a pen normally
  • Q: “Can you do up + undo your buttons?”
86
Q

Hand exam - special tests: median nerve

A
  • Thumb abduction against resistance
    …
  • Tinel’s test - tap wrist
  • Phalen’s test - ‘reverse prayre’
  • Compress wrist
87
Q

Hand exam - special tests: ulnar nerve

A
  • Cross index + middle finger
  • Grip paper between thumb + index finger, without flexing thumb joint
  • Abduct fingers against resistance
88
Q

Hand exam - special tests: radial nerve

A
  • Wrist + finger extension against resistance
89
Q

Presenting a hand examination

A
  • I performed a hand examination on ___, a ___ year old male/female
  • On general inspection of the hands/elbows there was no evidence of any hand pathology
  • On palpation, the joints were not overly warm, there was no tenderness over the bones/joints, sensation was fully intact and the vascular component did not appear compromised
  • Full range of movement in all modalities tested
  • Special tests were negative
  • In summary, this was a normal hand examination
  • TO COMPLETE MY EXAMINATION I WOULD…
90
Q

How would you complete a hand examination?

A
  • Full neurovascular assessment of upper limb
  • Examine elbow (+shoulder)
  • View relevant imaging
91
Q

Shoulder examination - general structure

A
  • Intro
  • General inspection
    …
  • Look
  • Function
  • Feel
  • Move
    - Active - screening
    - Active - specific
    - Passive
  • Special tests
    …
  • Thank patient
  • Present exam
  • To complete…
92
Q

Shoulder exam - look

A
  • Anterior
  • Sides
  • Posterior
  • Scapular winging (press on wall)
93
Q

Shoulder exam - function

A
  • Q: “Can you wash your hair?”
  • Q: “Can you dress yourself without problems?”
94
Q

Shoulder exam - feel

A
  • Temperature
    …
  • Bones
  • Muscle bulk
  • Scapula on back
95
Q

Shoulder exam - active movement

A

Screening movements
* Hands behind head, elbows back
* Hands behind back
…
Specific movements
* Abduction and adduction
* Flexion and extension
* Internal + external rotation (elbows at 90˚)

96
Q

Shoulder exam - passive movement

A
  • Abduction and adduction
  • Flexion and extension
  • Internal + external rotation (elbows at 90˚)
97
Q

Shoulder exam - special tests

A
  • Empty can test
    - Arm out, to 60˚, thumb to floor, apply resistance
  • Painful arc test
    - Passively lift arm all the way up
    - Patient actively slowly adducts arm
  • Resisted abduction
  • Resisted external rotation
  • Lift off test (resisted internal rotation)
    - Hand on L spine
    - Palm to palm resist examiner pushing in
  • Scarf test
    - Hand on opposite shoulder
    - Apply pressure to elbow
98
Q

Presenting a shoulder examination

A
  • I performed a shoulder examination on ___ , a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest
  • On closer inspection there was no evidence of pathology
  • On palpation, there was no tenderness over….
  • The patient had a full range of movement in all modalities tested
  • Special tests were negative
  • In summary, this was a normal shoulder examination
  • TO COMPLETE MY EXAMINATION I WOULD…
99
Q

How would you complete a shoulder examination?

A
  • Full neurovascular assessment of upper limb
  • Examine elbow + C spine
  • View relevant imaging
100
Q

Hip examination - general structure

A
  • Intro
  • General inspection
    …
  • Function
  • Look
  • Feel
  • Move
    - Active
    - Passive
  • Special tests
    …
  • Thank patient
  • Present exam
  • To complete…
101
Q

Hip exam - function

102
Q

Hip exam - look

A

Standing up
* Anterior
* Sides
* Posterior
…
Lying down
* Inspect hip
…
Leg length
* Assumed - xiphisternum to medial malleolus
* Actual - ASIS to medial malleolus
* Assess for leg length discrepancy

103
Q

Hip exam - feel

A
  • Temperature
    …
  • General feel
  • Greater trochanter
104
Q

Hip exam - active movement

A
  • Flex + extend
  • Abduct + adduct
105
Q

Hip exam - passive movemnt

A
  • Flex + extend
  • Abduct + adduct
  • Rotation in extension
  • Rotation in flexion
  • Extension lying on front
106
Q

Hip exam - special tests

A
  • Thomas’s test
    - Your hand under L spine, palm up
    - Passively flex one leg
    - +ve if other leg raises up
  • Trendelenburg’s test
    - Patient’s hands on your shoulders
    - Your hands on patient’s iliac crests
    - Raise one leg
    - +ve if pelvis drops on side of raised leg
107
Q

Presenting a hip examination

A
  • I performed a hip examination on ___ , a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest, gait was normal
  • On closer inspection there was no evidence of pathology
  • On palpation, there was no tenderness over….
  • The patient had a full range of movement in all modalities tested
  • Special tests were negative
  • In summary, this was a normal hip examination
108
Q

How would you complete a hip examination?

A
  • Full neurovascular assessment of lower limb
  • Examine knee + L spine
  • View relevant imaging
109
Q

Knee examination - general structure

A
  • Intro
  • General inspection
    …
  • Function
  • Look
  • Feel
  • Move
    - Active
    - Passive
  • Special tests
    …
  • Thank patient
  • Present exam
  • To complete…
110
Q

Knee exam - function

111
Q

Knee exam - look

A

Standing up
* Anterior
* Sides
* Posterior
…
Lying down
* Inspect knee

112
Q

Knee exam - feel

A
  • Temperature
    …
    Knee in extension
  • Tendon
  • Kneecap
  • Joint margins
  • Popliteal fossa
    …
  • Patellar tap
  • Sweep test
    - Up medial
    - Down lateral
    …
    Knee in flexion
  • Tendon
  • Kneecap
  • Joint margins
  • Popliteal fossa
113
Q

Knee examination - active movement

A
  • Flexion
  • Extension
114
Q

Knee examination - passive movement

A
  • Flexion
  • Extension
  • Hyperextension
115
Q

Knee examination - special tests

A
  • Posterior sag test
    - Knee flexed to 90˚
    - Observe for sag
  • Anterior draw test
    - Knee flexed to 90˚
    - Hands round tibial tuberosity
    - Pull forwards
  • Varus stress
  • Valgus stress
116
Q

Presenting a knee examination

A
  • I performed a knee examination on ___ , a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest, gait was normal
  • On closer inspection there was no evidence of pathology
  • On palpation, there was no tenderness over….
  • The patient had a full range of movement in all modalities tested
  • Special tests were negative
  • In summary, this was a normal knee examination
  • TO COMPLETE MY EXAMINATION I WOULD…
117
Q

How would you complete a knee examination?

A
  • Full neurovascular assessment of lower limb
  • Examine hip + ankle
  • View relevant imaging
118
Q

C spine examination - general structure

A
  • Intro
  • General inspection
  • Any pain?
    …
  • Look
  • Feel
    - Percuss
  • Move
    …
  • (Pulses in arms)
    …
  • Thank patient
  • Present exam
  • To complete…
119
Q

C spine exam - look

A
  • Anterior
  • Sides
  • Posterior
120
Q

C spine exam - feel

A
  • Posterior
  • Sides
  • Paraspinal muscles
  • Subclavicular area
    …
  • Percuss C spine
121
Q

C spine exam - active movement

A
  • Flexion - chin to chest
  • Extension - look at ceiling
  • Lateral flexion - ear to shoulder
  • Lateral rotation - turn head left + right
122
Q

C spine exam - passive movement

A
  • Hold head with one hand, to create the movements
  • Other hand on neck to feel for crepitus
    …
  • Flexion
  • Extension
  • Lateral flexion
  • Lateral rotation
123
Q

C spine exam - extra final step

A
  • (Pulses in arms)
124
Q

Presenting a C spine examination

A
  • I performed a Spine examination on ___, a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest
  • On palpation there was no tenderness along the vertebrae or the paraspinal muscles
  • There was a full range of movement throughout the spine
  • In summary, this was a normal spine examination
  • TO COMPLETE MY EXAMINATION I WOULD…
125
Q

How would you complete a C spine exam?

A
  • Neurovascular examination of upper limbs
  • Examine peripheral pulses
  • Examine shoulder + L spine
126
Q

L spine examination - general structure

A
  • Intro
  • General inspection
  • Any pain?
    …
  • Look
  • Gait
  • Feel
    - Percuss
  • Move
  • Special tests
    …
  • Thank patient
  • Present exam
  • To complete…
127
Q

L spine - look

A
  • Anterior
  • Sides
  • Posterior
128
Q

L spine - gait

A
  • Observe for Trendelenburg’s sign
129
Q

L spine - feel

A
  • Vertebrae + between vertebrae
  • Sacroiliac joints
  • Paraspinal muscles
    …
  • Percuss spine
130
Q

L spine - active movements

A
  • Flexion - touch toes, legs straight
  • Extension - lean back
  • Lateral flexion - reach down side of leg, legs straight
  • Lateral rotation - cross arms across chest, twist to each side
131
Q

L spine - passive movements

A
  • Flexion
  • Extension
  • Lateral flexion
  • Lateral rotation
132
Q

L spine - special tests

A
  • Schober’s test
    - Mark points on spine, should increase
    - Patient flexes spine - touches toes
  • Sciatic stretch test/straight leg raise
    - Lie on back, passively flex hip, leg extended
    - Dorsifelx foot
  • Bowstring test
    - Lie on back, passively flex hip, leg extended
    - Flex knee slightly
    - Apply firm pressure with thumb in popliteal fossa
  • Femoral stretch test
    - Lie on front, flex knee, extend hip
    - Plantarflex foot
    …
  • Chest expansion in 4th intercostal space
133
Q

Presenting an L spine examination

A
  • I performed a Spine examination on ___, a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest
  • Trendelenburgs’ sign was not present, and gait appeared normal
  • On palpation there was no tenderness along the vertebrae or the paraspinal muscles
  • There was a full range of movement throughout the spine
  • Schober’s test, straight leg raise, Bowstring’s and the femoral stretch tests were negative
  • In summary, this was a normal spine examination
  • TO COMPLETE MY EXAMINATION I WOULD…
134
Q

How would you complete a L spine exam?

A
  • Neurovascular examination of upper limbs
  • Abdo exam
  • Rectal exam
  • Examine peripheral pulses
  • Examine hip + C spine
135
Q

GALS examination - general structure

A
  • Intro
  • Screening questions
  • General inspection
  • Look
    …
  • Gait
  • Arms
  • Legs
  • Spine
    …
  • Thank patient
  • Present exam
  • To complete…
136
Q

GALS exam - screening questions

A
  • “Do you have any pain or stiffness in your muscles, joints or back?”
  • “Are you able to completely dress and undress yourself without any difficulty?”
  • “Are you able to climb up and down stairs without any difficulty?”
137
Q

GALS exam - look

A
  • Anterior
  • Sides
  • Posterior
138
Q

GALS exam - gait

A
  • Walk there and back
  • Examine footwear
139
Q

GALS exam - arms

A

Movements
* Hands behind head, shoulders back
* Arms out, palms down - look
* Arms out, palms up - look
* Make a fist
* Squeeze my fingers
* Pincer grip - touch fingers to thumb
…
MCP joint squeeze

140
Q

GALS exam - legs

A

Lie on bed
Movements
* Passive flexion - feel for crepitus
* Passive extension - feel for crepitus
* Flex to 90˚, passive internal + external rotation
…
Patellar tap
…
Inspect feet
MTP joint squeeze

141
Q

GALS exam - spine

A

C spine
* Neck side to side
…
L spine
* Fingers on back
* Bend over and touch toes
* Fingers should spread

142
Q

Presenting a GALS examination

A
  • I performed a GALS examination on ___, a ___ year old male/female
  • On general inspection, he/she appeared comfortable at rest and there was no obvious pathological gait, or pathology in the arms, legs and spine
  • Palpation did not reveal any MSK pathology
  • ROM was normal in all modalities tested
  • In summary, this was a normal GALS examination
  • TO COMPLETE MY EXAMINATION I WOULD…
143
Q

How would you complete a GALS examination?

A
  • Focused exam of joints/systems with suspected pathology
  • View relevant imaging
144
Q

Diabetic foot examination - general structure

A
  • Intro
  • General inspection
  • Gait
    …
  • Inspect feet
  • Palpate feet
  • Vascular
  • Ankle jerk reflex
  • Sensation
    …
  • Thank patient
  • Present exam
  • To complete…
145
Q

Diabetic foot exam - gait

A
  • Walk there and back
  • Examine footwear
146
Q

Diabetic foot exam - inspect foot

A
  • Skin
  • Deformities
147
Q

Diabetic foot exam - palpate foot

A
  • Bones
  • Joints
    (Watch face)
148
Q

Diabetic foot exam - vascular

A
  • Temperature
  • Pulses
    - Posterior tibial
    - Dorsalis pedis
    - Popliteal
  • CRT - big toe
149
Q

Diabetic foot exam - reflexes

A
  • Ankle jerk reflex
150
Q

Diabetic foot exam - sensation

A
  • Light touch
  • Pressure
    …
  • Proprioception
  • Vibration
151
Q

Diabetic foot exam - sensation: where are you testing?

A
  1. Big toe
  2. 3rd toe
  3. 1st MTPJ
  4. 3rd MTPJ
  5. 5th MTPJ
    And then onwards if no sensation here
152
Q

Presenting a diabetic foot examination

A
  • I performed a diabetic foot examination on ___ , a ___ year old male/female
  • On general inspection, the patient appeared comfortable at rest and gait was normal
  • My neurovascular assessment of both feet were normal; Sensation was intact in both feet (if it was lost, you say where it was lost up to e.g. ‘light touch sensation
    was absent from the feet to the knees)
  • In summary, this was a normal diabetic foot examination
  • TO COMPLETE MY EXAMINATION I WOULD…
153
Q

How would you complete a diabetic foot examination?

A
  • Examine pin-point/pain and temperature sensation
  • Check capillary blood glucose + serum HbA1c
  • Lower limb neuro examination
  • Peripheral vascular exam + venous sufficiency exam
  • Calculate diabetic foot risk score
154
Q

Peripheral vascular examination - general structure

A
  • Intro
  • General inspection
    …
  • Hands
  • Upper pulses
  • Face
    …
  • Abdomen
    …
  • Legs
  • Lower pulses
    …
  • Auscultate
  • Buerger’s test
    …
  • Thank patient
  • Present exam
  • To complete…
155
Q

Peripheral vascular exam - hands

A
  • Inspect
  • CRT
156
Q

Peripheral vascular exam - upper pulses

A
  • Radial
    - Rate + rhythm
    - Compare sides
  • Ulnar pulses
  • Allen’s test
  • Brachial pulses
  • Carotid pulses
157
Q

Peripheral vascular exam - face

A
  • General
  • Eyes
  • Mouth
158
Q

Peripheral vascular exam - abdomen

159
Q

Peripheral vascular exam - legs

A
  • Inspect
  • Lower pulses
  • CRT - big toe
  • Light touch sensation (distal–>proximal)
  • Power
160
Q

Peripheral vascular exam - lower pulses

A
  • Aorta
  • Femoral pulses
  • Popliteal pulses
  • Dorsalis pedis pulses
  • Posterior tibial pulses
161
Q

Peripheral vascular exam - auscultate

A
  • Carotid arteries
  • Subclavian arteries
  • Aorta
  • Femoral arteries
162
Q

Peripheral vascular exam - Buerger’s test

A
  • Hold legs at 45˚
  • Then hang both legs off end of bed
163
Q

Presenting a peripheral vascular examanination

A
  • I performed a peripheral arterial examination on ___, a ___ year old male/female
  • On general inspection, he/she appeared well at rest
  • On closer inspection, there were no stigmata of peripheral arterial disease
  • Pulses were present bilaterally in upper and lower limbs and had normal rate, rhythm and character at ___bpm
  • Abdominal aortic pulse was not palpable
  • Sensation of the lower limb was intact
  • In summary, this was a normal peripheral arterial examination
  • TO COMPLETE MY EXAMINATION I WOULD…
164
Q

How would you complete a peripheral vascular examination?

A
  • Measure blood pressure in arms and ankles
  • Calculate ankle-brachial pressure index
  • Cardiovascular examination
  • Upper limb + lower limb neuro examinations
  • Doppler ultrasound
165
Q

Varicose veins examination - general structure

A
  • Intro
  • General inspection
    …
  • Thighs
  • Varicosities
  • Calves + feet
    …
  • (Abdomen)
    …
  • Thank patient
  • Present exam
  • To complete…
166
Q

Varicose veins exam - thighs

A
  • Inspect legs
  • Find + inspect SFJ
  • Cough test
  • Tap test
    - Tap SFJ, feel for transmission waves in varicosities lower down
167
Q

Varicose veins exam - varicosities

A
  • Temperature
  • Palpation
  • Tap test
    - Tap variscocity, feel for transmission waves in SFJ
  • Auscaltate
168
Q

Varicose veins exam - calves

A
  • Pitting oedema
  • Pulses
    - Femoral pulses
    - Popliteal pulses
    - Dorsalis pedis pulses
    - Posterior tibial pulses
169
Q

Varicose veins exam - abdomen

A
  • (Inspect abdomen)
170
Q

Presenting a varicose veins examination

171
Q

How would you complete a varicose veins examination?

A
  • Trendelenburg test with a tourniquet
  • Perthe’s test
  • Doppler ultrasound
  • Venous duplex scanning
  • Measure blood pressure in arms and ankles
  • Calculate ankle-brachial pressure index
  • Peripheral vascular examination
  • Abdominal examination

2b Content OSCE Stan (4 decks)

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