FOSCE 2

Question 1

when summarising the practical examination, what do we need to say

Answer 1

Name, age, occupation, gender,
outline the problem they presented with - biomedical and patient perspective
summarise the relevant background information for the presentation
summarise the relevant examination findings including any negatives

Question 2

what do we need to do for gait examination

Answer 2

WIPER -
ask the patient to remove their shoes and socks
thank patient at the end

Question 3

what movements does the patient need to do

Answer 3

need them to walk across the room one way, stop turn around. we watch from the back first
then they do the same as we watch from the side

Question 4

what are we looking for in the gait examination

Answer 4

symmetry and cadance, balance, stride length ( even on both sides), gait pattern (limp or disorder) use of walking aid. how well they stop, turn and change direction
and how easily they remove shoes, normal arm swing?

Question 5

example of a gait report

Answer 5

“Today I was asked to see Mrs Alice Talalima, a 73-year-old woman who is a retired
schoolteacher. She had her right hip replaced 6 months ago and has come for a checkup.
I examined Mrs Talalima’s gait.
Mrs Talalima walked without a walking aid.
Her gait had a normal rhythm. She was steady throughout the examination. The length of her stride was normal in each leg. She did not have a limp and had normal arm swing. She had no difficulty with turning around and changing direction.
In summary her gait was normal.”

Question 6

what do we need to do for a shoulder look and feel?

Answer 6

WIPER
ask patient to remove layers in such a way that the shoulders are visible - can give gown

Question 7

what are we looking and feeling for in a shoulder examination

Answer 7

looking for: arms at the same level, shoulder contours and outlines of the acromioclavicular joints are the same, deltoid wasting, scars, skin changes, size and position of the scapula (elevated, depressed or winged?)
then we palpate the clavicle from the acromioclavicular to the sternoclavicular, palpate the acromioclavicular joint, palpate the coracoid process.

Question 8

what do we do for a shoulder move examination

Answer 8

WIPER
remove clothing in such a way that the shoulders are exposed
and we look at all of this from the side and the back

Question 9

what movements does the patient need to do in a move shoulder exam

Answer 9

lift their arm upwards in front of them to 180, swing their arms back as far as possible, move arms one at a time across their chest, ask them to lift arm from side as far as possible, ask patient to put their hand as far up their back as possible. get them to bend elbow to 90 degrees and rotate the shoulder in and out

Question 10

what do we say after a shoulder look and feel exam give example

Answer 10

Today I examined Sally Peterson who wrenched her right shoulder when her dog pulled suddenly on the lead when it was scared by another dog walking towards them. Sally is a 72 year old retired financial planner. On examination Sally looked well. She had difficulty taking her cardigan and top off due to pain in her right shoulder. On examination of the shoulders the contours were normal bilaterally. The skin was normal. so to was scapula position and size. There was no tenderness to palpation bilaterally, of the acromioclavicular joint nor the coracoid process.

Question 11

what do we say for a shoulder movement examination

Answer 11

all the details then On assessment of the range of movement in the right shoulder Sally had normal active flexion and extension. She had full abduction, and she had pain from 60-120 degrees, full adduction. She had reduced active and passive internal and external rotation on the right. She had full range of motion in the left shoulder.

Question 12

what do we need to do in a cervical spine examination

Answer 12

WIPER
get them to be clothed in a way that the entire cervical spine is visible
ask them to sit, observe patient from the side and back
ask permission to touch when doing so
then ask them to complete movements

Question 13

what are we looking for and feeling for in a cervical spine examination

Answer 13

we are looking for the muscle bulks and the symmetry of the spine, also looking at the curve of the cervical spine
feeling the midline feeling the cervical processes from occipital to the T1
palpating the soft tissues either side of the cervical spine

Question 14

what movements do the patients need to do in the cervical spine exam

Answer 14

tilt their head side to side, touching each ear to shoulder
ask patient to look up and down as far as possible
ask patient to look over each shoulder

Question 15

whats the summary for a cervical exam

Answer 15

today i saw shela luckhurst who is a 19 year old woman working at rob roy diary. she came in today presenting with intense neck pain that began after netball on Saturday.
upon examination he lordotic curve was normal as was the alignment of her cervical vertebrae and muscle bulk. there was no pain when palpating the spinous processes or paravertebral tissues.
shela had a full normal range of motion in the cervical spine, with normal flexion, extension, left and right rotation, and normal lateral flexion to the left and right
all in all it was a normal examination

Question 16

what do we need to do for a thoracic spine examination

Answer 16

WIPER -
get them to remove clothes so that entire spine is visible
get them to stand as we observe from side and back

Question 17

what do we look for and feel for in a thoracic spine examination

Answer 17

look from back and side assessing the kyphotic curve of the lumbar spine, assess muscle bulk and assess symmetry
we feel the midline spinous processes from T1-T12 and feel the paraspinal soft tissues of the thoracic spine
looking for tenderness, tension, alignment

Question 18

what movement does patient do in a thoracic movement examination

Answer 18

get them to sit with their arms crossed and ask them to rotate their trunk as far as possible in both directions

Question 19

give an assessment of a thoracic spinal exam

Answer 19

joe jones is a 19 year old male who is a WINZ backbone presenting with a sore backbone after backboning so hard. he had some difficulty removing his clothes but upon examination his kyphotic curve was normal as was his muscle bulk, alignment and symmetry. upon palpation of his vertebrae he had no pain or tenderness and alignment was normal, no pain in paravertbral fats.
patient had full range of motion when they were doing right and left lateral rotation movements. so joe had a normal thoracic spine exam

Question 20

what do we need to do for a lumbar spine exam

Answer 20

WIPER
get them to be clothed so we can see the thoracic spine, get them to stand
look at the lumbar spine from the side and the back

Question 21

what are we looking for and feeling for in a lumbar exam

Answer 21

from side and back we look at the lordotic curve, muscle bulk, alignment, the level of iliac crests
we feel for the level of the iliac crests, any pain when palpating the lumbar vertebrae, also feeling the paraspinal soft tissues

Question 22

what movements does the patient do in a lumbar spine assessment

Answer 22

touch their toes keeping their legs straight, straighten up and lean as far back as possible, laterally flex on both sides with arm straight down to see how far they can go down either side

Question 23

give an assessment of a lumbar spine examination

Answer 23

we saw felix calder who is a 20 year old male who works on checkouts at new world, he has presented with pain in the lower back whilst standing doing long shifts.
upon examination i saw a normal lumbar lordosis with normal posture, muscle bulk and symmetry.
upon palpation of his lumbar vertebrae he had no pain nor tenderness and his alignment was normal, iliac crests were at the same height
he wasn able to touch his toes without bending his knees and could bend back to a normal degree. he also had symetrical levels of lateral flexion to the left and right
so felix had a normal lumbar spine examination