OSCE

Question 1

Skin changes in peripheral venous examination:

Answer 1

Varicose veins: long (medial) or short (back leg) saphenous distribution
Venous eczema
Oedema
Lipodermatosclerosis (chronic venous insufficiency)
Haemosiderin deposits
Venous ulceration (above medial malleolus)

Question 2

Where is the saphenofemoral junction?

Answer 2

4cm lateral and inferior to the pubic tubercle

Question 3

Which special tests are required in a peripheral venous examination?

Answer 3

Trendelendburg test (tourniquet test): raise the legs, milk them, place tourniquet over the SFJ and ask the patient to stand up to observe filling

Perthe’s test: tourniquet at the SFJ, walk around the room for 5 minutes, varicose veins less distended = no deep venous insufficiency, if they are the same or more distended = deep venous insufficiency

Question 4

What investigations are needed to complete a peripheral venous exam?

Answer 4

Venous duplex scan: varicosity

Doppler of SFJ (second whoosh = blood falls back through incompetent valve)

Question 5

What else should be examined after a peripheral venous examination?

Answer 5

Abdominal exam

Peripheral arterial exam

Question 6

What signs should you look for in the face during a peripheral arterial exam?

Answer 6

Conjunctival pallor - anaemia (worsens ischaemic symptoms)

Corneal arcus - hyperlipidaema (risk factor for PAD)

Question 7

What signs are you looking for in the legs in a peripheral vascular exam?

Answer 7

Colour - necrosis/pallor
Scars - bypass surgery
Trophic changes - hair loss, shiny skin, wasting of subcutaneous tissue
Ulceration - arterial ulcers commonly peripheral, well defined, painful
Missing digits/toes

Question 8

Which modalities should be grossly assessed in a peripheral vascular exam?

Answer 8

Gross motor (wiggle toes)
Gross sensation (start distal)

Question 9

What bloods should you order in a confusion screen?

Answer 9

FBC, U&E, LFT, ESR/CPR
Calcium
TFTs
Clotting
Haematinics

Question 10

How do you perform Schober’s test?

Answer 10

Mark 5cm below PSIS midline and 10cm above
Ask the patient to touch toes
Measure between the two marks
<20cm = reduced flexion of lumbar spine

Question 11

Which questions should be specific asked in a gynae history?

Answer 11

MOSC

Menstrual history
Obstetric history
Sexual history
Cervical smear/contraception

Question 12

How would you complete a shoulder examination?

Answer 12

Neurovascular examination of the upper limbs.
Examination of the joints above and below (cervical spine and elbow joint).
Further imaging if indicated (e.g. X-ray and MRI).