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OSCE > MSK OSCE > Flashcards

MSK OSCE Flashcards

1
Q

What do you look for in a lumbar spine exam

A 
muscle wasting
asymmetry
scoliosis (from back)
posture
normal kyphosis and lordosis (from side)
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2
Q

what do you feel for in a lumbar spine exam

A

vertebrae and sacroiliac joint for tenderness

para-spinal muscles for tenderness

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3
Q

what do you move in a lumbar spine exam

A

3 fingers over spine- bend forward (flexion)

lateral flexion (run hand down side of leg)

thoracic rotation (sat down)

straight leg raise (flat on bed- pain= nerve root irritation)

DORSIFLEXION of big toe- L5 nerve root problem

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4
Q

what reflexes do you illicit in a lumbar spine exam

A

patella

ankle jerk

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5
Q

what end pieces would u discuss in a lumbar spine exam

A

if indicated:

peripheral nerve exam of the lower limb

peripheral vascular exam of the lower limb

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6
Q

what would you look for in a cervical spine exam

A

sitting and standing for:

posture
normal cervical lordosis

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7
Q

what do you feel for in a cervical spine exam

A

palpate the spine for alignment and tenderness

palpate paraspinal muscles, trapezius and upper back muscles for tenderness

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8
Q

what do you move in a cervical spine exam

A

flexion (tilt head down) and extension (tilt head back)

lateral flexion (ear to shoulder)

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9
Q

what reflexes would you elicit for a cervical spine exam

A

biceps

triceps

supinator

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10
Q

what end pieces would you discuss for a cervical spine exam

A

peripheral nerve exam of the upper limb

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11
Q

what would you look for in an elbow exam

A

in anatomical position

for carrying angle, flexion deformity

scars, rashes, muscle wasting, swelling

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12
Q

feel in elbow exam

A

temp

palpate elbow joint at 90 degrees flexion (note epidcondyles and olecranon process)

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13
Q

move elbow exam

A

full range of flexion and extension

pronation and supination

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14
Q

reflexes elbow exam

A

apparently none

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15
Q

function elbow exam

A

reach mouth

reach behind head

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16
Q

look foot and ankle exam

A

with feet overhanging couch:
forefoot for nail changes, rashes, alignment, swelling

footwear for insoles

with weight bearing:
forefoot for toe alignment
mid foot for foot arch position

from behind:
achilles tendon
alignment

17
Q

feel foot and ankle exam

A

temp
pulses

squeeze MTP joints
palpate the whole foot including both malleoli, 5th metatarsal and navicular

18
Q

move foot and ankle exam

A

inversion and eversion

dorsiflexion and plantar flexion

rotation of mid tarsal joint (fix the heel and invert the foot passively)

19
Q

function foot and ankle exam

A

observe gait cycle

for heel strike, stance, toe-off

20
Q

look hand and wrist exam

A

palms down for swelling, deformity, wasting, scars,

palms up for muscle wasting at the eminences (thenar wasting= carpal tunnel syndrome) , dupytrens contracture

check for scar at wrist (carpal tunnel surgery)

nails for pitting/ oncholysis (present in psoriasis), clubbing, splinter haemorrhages

21
Q

feel hand and wrist exam

A

palms up for muscle wasting, median and ulnar nerve sensation (both eminences and index finger and little finger- should be the same)

palms down for radial nerve sensation (web between thumb and index finger), squeeze MCP joints

temperature of forearm

palpate wrist bimanually

radial pulse

run hand up ulnar border for plaques/ nodules (psoriasis)

22
Q

move hand and wrist exam

A

wrist flexion and extension active and passive

finger flexion, extension, adduction and abduction

thumb abduction

23
Q

function hand and wrist exam

A

grip 2 fingers with hand to assess grip strength

pinch 1 finger for pincer grip

24
Q

look hip exam

A

standing for muscle wasting (note gluteal region bulk)

supine for leg length and deformity and scars

25
Q

feel hip exam

A

palpate over greater trochanter for tenderness

26
Q

move hip exam

A

with knee flexed assess full hip flexion

Thomas’ test= 1 hand on back- fully flex hip- other leg should stay on bed

Trendelenberg test= stand on one leg- positive= pelvis dipping on contralateral side (bad)

27
Q

function hip exam

A

assess gait for limp

28
Q

look knee exam

A

swelling, redness, inflammation

muscle wasting, scars

walking aids

29
Q

feel knee exam

A

temp

palpate knee joint and behind for baker’s cyst

patellar tap test

30
Q

move knee exam

A

active and passive flexion and extension

anterior and posterior drawer test (ACL and PCL)

medial and lateral collateral ligament stability (medial palm over knee, lateral fingers on knee joint to feel joint line)

31
Q

function knee exam

A

assess gait

look for bakers cyst

32
Q

look shoulder exam

A

front side and behind

for symmetry, posture, wasting, scara

33
Q

feel shoulder exam

A

temperature

palpate from sternoclavicular joint all the way round on the clavicle to the scapula

palpate glenohumeral joint from front and back

palpate muscles: supraspinatus, infraspinatus, deltoid

34
Q

move shoulder exam

A

hands behind head (External rotation)

hands behind back (internal rotation)

external rotation with elbow flexed at 90 degrees

flexion and extension

abduction (look from behind at scapula)

35
Q

inspection GALS exam

A

in anatomical position- front side and back:

  • muscle bulk/ wasting
  • spine alignment
  • limb alignment, carrying angle
  • popliteal swelling
  • foot abnormalities (arches, hallux valgus)
36
Q

Gait GALS exam

A 
observe:
symmetry 
length of stride
smoothness
turning speed
37
Q

Arms GALS exam

A

behind head and behind lower back

arms outstretched (palms down) look for swelling
squeeze MCP joints

make a fist, squeeze hand, pinch finger

38
Q

Legs GALS exam

A

supine inspect for bulk and deformity

knee flexion and extension
patellar tap test

flexion and internal rotation of hip joint

39
Q

Spine GALS exam

A

cervical spine movement (up, down, ear to shoulder)

lumber flexion with 3 fingers on spine

OSCE (1 decks)

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