OSCE Flashcards
Urinalysis: Causes of glucose in urine
Diabetes Mellitus
SGLT2i
Renal tubular disease
Urinalysis: what causes bilirubin in urine?
Conjugated bilirubin
Biliary obstruction e.g. pancreatic cancer
Urinalysis: causes of Ketones in urine
Indicates fatty acid metabolism
Starvation
Diabetic ketoacidosis
Urinalysis: causes of high or low specific gravity
= amount of solute dissolved in the urine
Low = dilute urine
- diabetes insipidus
- Acute tubular necrosis
High = concentrated urine
- dehydration
- diabetes Mellitus
- proteinuria e.g. nephrotic syndrome
Urinalysis: causes of high or low pH
Normal range 4.5 - 8
Low = starvation, diabetic ketoacidosis, sepsis High = UTI, vomiting, diuretics
Urinalysis: causes of blood in urine
UTI
Renal stones
Nephrotic syndrome
Malignancy in urinary tract
Urinalysis: causes of protein in urine
Nephrotic syndrome
Chronic kidney disease
Urinalysis: causes of nitrates in urine
Breakdown product of gram negative organisms e.g. e.coli
UTI
Urinalysis: causes of high or low urobilinogen in urine
Normal bilirubin breakdown product 0.2-1.0 mg/dL
Low = biliary obstruction High = haemolysis e.g. anaemia, malaria
Urinalysis: causes of leukocyte esterase in urine
= an enzyme produced by neutrophils, so it indicates the presence of white blood cells in urine
UTI
Anything that causes haematuria
Respiratory exam
End of bed - ask how they’re feeling Look at hands - hold out hands for tremor,CO2 flap, finger clubbing Pulse and resp rate Look at eyes, pull down lids Look inside mouth and under tongue Feel trachea Chest expansion Percuss front then axilla Auscultate front then axilla (4 places anterior and 3 axilla) Repeat on back Lymph nodes JVP - 45 degrees, look to left Look at legs for oedema, rashes, DVT
Peak Flow Measurement
Ask if they’ve done this before Make sure peak flow is marked with EU standard Use clean tube and reset meter Best to stand or sit up straight Deep inspiration Lips tightly around but keep fingers off of meter Deep inspiration and hard expiration Record best of 3 attempts Put tube in bin Get patients height Compare on chart
Full Cardio Examination
End of bed assessment - make sure exposed
Hands - finger clubbing, cap refill
Pulse - check of radio-radial delay, collapsing pulse
Blood pressure
Eyes and mouth
Examine chest
Locate apex beat and feel for heaves
Feel for thrills
Auscultate all 4 areas with different pressure on stethoscope
Turn on left hand side and listen at apex to accentuate mitral stenosis
Sit forward and hold breath out and listen at parasternal edge for aortic regurgitation
Feel and Auscultate the carotids
Auscultate lung bases
JVP
Check for sacral and peripheral oedema
Precordial Examination
Inspections
Palpation - heaves at apex, thrills over each area
Auscultate at 4 areas with both pressures of stethoscope
Turn on left hand side and listen at apex for mitral stenosis
Sit forward and hold breath out and listen at parasternal edge for aortic regurgitation
Feel and auscultate carotid arteries
Listen at lung bases front and back
Peripheral Vascular examination
Inspect all sides and in between toes Feel for temperature all the way down Feel all pulses Cap refill Check for oedema Check for calf tenderness Buerger’s test? With patient lying down, hold both legs up for 1/2mins then sit them up and swing legs down. Look at colour changes throughout
GI Abdominal Exam + extra renal tests
Lie patient on back and fully expose down to ASIS
Inspect all areas
Sit down to be eye level with abdomen
Ask about pain
Palpate all nine areas first superficially then deep and look at patient throughout
Palpate for liver
Palpate for spleen and repeat with the rolled onto right
Palpate kidneys - bounce hand at back and see if you can feel from anterior surface, mostly looking for pain
Percuss liver up and down
Percuss up to spleen from RIF
If renal, Percuss for bladder - upper abdo down to pubic symphysis
Percuss from midline to flank then if you heard dullness, roll patient over, wait 10 seconds and re-percuss to see if it shifts
Auscultate for bowel signs - need to be absent for 2 mins before you can say theyre absent
Rectal Examination
Ask if theyve had this before
Explain exam and squeezing, get consent, explain chaperone and how to undress
Patient should be lying on left hand side with knees up to chest
Inspect
Insert finger and feel 360 degrees - prostate is on anterior wall
Assess anal tone
Look at finger when removed
Cover patient and clean up
Diabetes Lower limb exam
Remove socks and shoes and expose to at least the knee
Inspect all parts of the legs
Feel temperature all the way down
Feel the two foot pulses
Check for peripheral oedema
Cap Refill
Use 10g monofilament needle to check sensation at tip of 1st and 3rd toes and at metatarsal heads of 1st, 3rd and 5th toes
Look at inside of shoes for insoles and at outside for wear
Thyroid Examination
Inspect patient as a whole
Look at nails
Look at eyes
See if they are able to stand from seated position
Inspect neck fully
Look while swallowing water
Ask them to breath deeply to check for stridor
Otological examination
Inspection
Palpate mastoid and tragus
Otoscopy: use right hand for right ear, rest hand on cheekbone. Pull pinna out and up
Hearing test: At arms length, cover one ear and whisper to another. Repeat word back to me
Webers - centre of head
Rinne
Rombergs test - balance
Upper Limb Neuro Exam
Inspection
Arms outstretched palm down - look for essential tremor
Arms outstretched palm up - close eyes and look for movement
Assess tone - rigidity is always present, spasticity is velocity-dependent
Power -
Reflexes - biceps, supinator and triceps. Test once then if absent try reinforcement
Sensation - pain eyes open, light touch with eyes closed, vibration with tuning fork, proprioception move DIP of index finger up or down with eyes closed
Lower Limb Neuro Exam
Inspection
Assess tone - Rolling each leg, flexing and extending the knee, dorsiflex ankle with knee flexed
Assess power - Hip, knee, ankle up and down and side to side, big toe only (isolates L5)
Reflexes - Knee, ankle and plantar, reinforce only if necessary
Sensation - Show on upper before testing lower, medial and lateral thigh, antero-medial and lateral calf, lateral foot
Proprioception
Cerebellar Examination
Gait - walking, heel-to-toe, Rombergs for balance
Eyes - H test
Speech - British constitution, baby hippopotamus
Upper Limb - finger to nose, rapid hand movements, rebound phenomenon, assess tone, reflexes
Lower limb - heel-to-shin, rapid foot movements, assess tone, reflexes
Breast Examination
Explain + Chaperone + how to undress
Sit on edge of couch - inspect
Lift hands above head
Hands on waist
Lying flat on bed with arms above head - palpate breasts, ask about pain
Palpate Axilla - anterior, posterior, medial, apex
Pregnant Abdo Exam
Patient lying semi-up fully exposed down to ASIS
Inspect bump
Feel bump and measure from top of fundus to pubis symphysis
Feel for position of foetus
If late pregnancy - feel for head, if can feel it all in abdomen its 5/5 not engaged. If cant feel any in abdomen, it is 0/5 fully engaged
Auscultation with Pinard Horn and feel maternal pulse at same time
Female Pelvic Exam
Abdo exam first - inspection, palpation, percuss for fluid, ausculation
Feet together, knees apart, scooch bum down to edge of bed
Inspection - gently part labia
If an older women, ask to cough to check for prolapse
Bimanual examination - Lube finger, part labia and insert one finger, then two if 1 is ok
Feel cervix
Feel fornices
Feel uterus - push fingers anteriorly and press down on suprapubic area
Feel adnexa
Feel pouch of douglas - should be concave, if convex it indicates a mass
Female Speculum Exam
Set-up everything first - while patient is undressing
Lubricate speculum only a little
Put in with handles on right then rotate and hold open - may be ratchet
Look at cervix
Take smear test - rotate 10 times on cervix, 5 times in pot
May need to take swabs
‘Unlock’ speculum and retract slightly looking at walls then take out rotating again
Haematology Examination
Hands Face - eyes and mouth Look at neck - may need water Feel neck lymph nodes Feel axillary lymph nodes Inspect abdomen Feel inguinal lymph nodes Palpate abdomen - 9 areas superficial and deep, feel for liver and spleen and kidneys. If spleen not felt roll over Percuss - Liver and spleen Percuss for ascites Auscultate for bowel sounds and bruits
Spine Examination
Expose spine and ask about pain
Inspect from all sides
Feel all the way down to sacroiliac joints
Feel muscle bulk each side looking for spasm
Chest expansion if ankylosing spondylitis suspected
Move neck all directions
Move back - flexion, extension, lateral and rotation
Special test - Schober’s test, make dots on SI joints and 10cm above and 5cm below, bending forward should increase the gap to at least 20cm
Hip Examination
Expose hips, with only underwear below waist and ask about pain
Look with patient standing
Gait
Lying flat on couch look again more closely
Feel - lateral thigh of hip, ASIS and down inguinal area
Move - Flexion (active), internal and external rotation (hip 90 move foot in and out), adduction and abduction (leg straight and move out and cross over while holding opposite hip) (all passive)
Special Tests:
Trendelenburg’s - hold hands and ask patient to stand on one leg
Limb lengths - True from ASIS to medial maleolus, apparant from xyphoid process to medial maleolus
Thomas’ test (DONT NEED TO DO) - put hand on lumbar spine, ask patient to flex hip and see if the other leg slightly flexes as well
