OSCE Flashcards
What position should a patient be in for cardio exam?
45 degree angle
What do you check fingers for in cardio exam?
Peripheral cyanosis
Clubbing - ask to put fingers together
What would you check the mouth for in cardio exam?
Pallor
Central cyanosis
What do you check eyes for in cardio exam?
Conjunctival pallor
Lipid deposits
What does raise JVP in cardio exam indicate?
Right-sided heart failure
What do you look for on chest of patient during cardio exam?
Pacemaker
Scars
Check in axillary region too
How do you feel for an apex beat during cardio exam?
Start infero-lateral and move up and medically
Place hand where you would expect to find it
Use fingers of other hand to check it is in 5th intercostal space
How do you feel for right ventricular heave?
Place one hand in centre of chest
Heal of hand would be pushed up if positive
How do you feel for thrills during cardio exam?
At each valve location
Place hand horizontally
Start infero-lateral and move up
Mitral, tricuspid, pulmonary aortic
How do you auscultate the 4 valve sounds?
Place diaphragm of stethoscope at mitral valve location
Feel carotid pulse in neck at same time
This is to determine first heart sound
Work way up
How do you auscultate for carotid bruits?
Use diaphragm of stethoscope on each side of neck
Ask patient to take and hold deep breath in
What do you look for in hands for abdominal exam?
Clubbing Palmar erythema (caused primarily by pregnancy or secondary by liver cirrhosis)
What do you check the mouth for in abdominal exam?
Pallor
Ulcers
What do you check the eyes for in abdominal exam?
Lipid deposits
Anaemia
What are 5 things you check the abdomen for in abdominal exam?
Scars Hernias Cachexia Brushing Abdominal distension
How do you approach patient for abdominal exam?
Kneel down to patients level
Cover lower half with a sheet
How do you do liver palpation?
Ask to take deep breath in
Use finger-tip palpation
Start in RLQ
How do you percuss liver?
Start in RLQ
Should be by edge of costal margin
How do you do spleen palpation?
Support left loin with left hand
Start in RLQ
Ask to take deep breaths in
Use finger-tip palpation
How do you do kidney palpation?
1 hand in renal angle
1 hand underneath parallel to recurs sheath
Ask to take deep breaths in
Lower border may be palpable upon deep inspiration
How do you do descending colon palpation?
Finger-tip palpation
To LLQ
How do you do aortic palpation?
Both hands on opposite sides of umbilicus
Pulsation, not expansive movements
How do you auscultate for bowel sounds?
Listen for 15 seconds
Normal sounds every 5-10
High-pitched gurgling
What do you check hands for in respiratory examination?
Peripheral cyanosis
Clubbing
What do you check mouth for in respiratory exam?
Central cyanosis
Pallor
What do you check eyes for in respiratory exam?
Conjunctiva pallor for anaemia
What do you check chest for in respiratory exam?
Scars from thoracotomy
Bruising
Pain
What do you do when feeling the trachea in respiratory exam?
Warn it’s uncomfortable
Check it’s central
How do you check chest expansion in respiratory exam?
Place both hands on chest on costal margin
Check they rise equally
What do you have to remember to state once you have finished the respiratory exam?
That you would repeat it on the back
What do you check the bottle for in urine dipstick test?
BBE
Time to wait for results once dipped
What are the causes of glucose in urine?
Diabetes
Kidney damage
What are the causes of blood in urine?
UTI
Kidney stones
What are causes of protein in urine?
Dehydration’s
NSAIDs
Inflammation
What are the causes of ketones in urine?
Diabetes
Starvation
ED
What are the causes of alkaline urine?
Excessive vomiting
Kidney disease
What are the causes of acidic urine?
Diabetic ketoacidosis
Diarrhoea
What are the causes of leukocytes in urine?
UTI
Kidney stones
What are the causes of nitrites in urine?
UTI
What are the causes of positive specific gravity in urine?
Dehydration
Vomiting
Kidney failure
What are causes of misleading results in urine dipstick?
Out of date strips
Improperly stored strips
Checked at wrong times after dipping
What are causes of false positive blood in urine?
Exercise
Dehydration
Period
What are causes of false positive leukocytes in urine?
Urinary retention
What are causes of false positive protein in urine?
Concentrated urine from dehydration
What are causes of false negative glucose in urine?
+ vitamin C
What are causes of false negative ketones in urine?
Delayed examination
What are causes of false positive nitrites in urine?
Contamination
Exposure to air
What are causes of false negative specific gravity in urine?
Alkaline urine
What must you state after you exam each eye?
Optic disc is clear
Retinal vessels are visible
Macula is clear
What is the estimated systolic pressure?
Point when radial pulse disappears when cuff is inflated
