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MSK > OSCE > Flashcards

OSCE Flashcards

1
Q

What are you LOOKING for in a spinal exam?

A

Posture of the head, neck and shoulders
Thoraco-lumbar scoliosis (standing and bending forward)
Normal (or abnormal) curvature of the spine

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2
Q

What are you FEELING for in a spinal exam?

A

Cervical ribs
Enlarged lymph nodes
Spinous processes
Muscle bulk or spasm in paraspinal muscles
Asymmetry in iliac crest heights or pelvic tilt
Sacroiliac joints
Chest expansion if AS suspected

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3
Q

What MOVEMENTS do you test in a spinal exam?

A

Flexion and extension of cervical spine
Rotation of cervical spine
Lateral flexion of cervical spine
Flexion and extension lumbar spine
Lateral flexion of lumbar spine

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4
Q

Which special test needs to be done in a spinal exam?

A

Schober’s test (the one with the measuring tape)

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5
Q

What are you LOOKING for in a hand exam?

A

Sclerodactyly
Psoriatic nail changes
Dupuytren’s
Mallet finger
Gouty tophi
Clawing
Swelling at any joints
Ulnar deviation
Bouchard’s and Heberden’s nodes
Swan neck deformity
Boutonniere deformity
‘Z’ shaped thumb
Muscle wasting

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6
Q

What are you FEELING for in a hand exam?

A

Temperature
Tenderness at MCPs
Feel all joints

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7
Q

What movements need to be done in a hand exam?

A

Close fist
Finger extension and flexion
Finger abduction and adduction
Thumb opposition

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8
Q

How do you test an RA patient’s hand function?

A

Power of pincer grip
Fine pinch (picking up coin)
Tripod grip (holding a pen)
Power grip
Hook grip

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9
Q

How do you test the innervation in the hand?

A

Dorsal:
- Base of thumb (radial)
- Pinkie (ulnar)
- Tip of index finger (median)
Palmar
- Index finger (median)
- Pinkie (ulnar)
- Lateral proximal part of thumb (radial)

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10
Q

What signs not on the hands would you look for in a hand exam?

A

Episcleritis/scleritis - RA
Malar rash - SLE

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11
Q

What are you LOOKING for in a wrist exam?

A

Deformity
Swelling
Scars
Muscle wasting

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12
Q

What are you FEELING for in a wrist exam?

A

Distal radio-ulnar joint
Ulnar styloid
Anatomical snuff box

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13
Q

Which movements do you do in a wrist exam?

A

Flexion and extension
Radial flexion and ulnar flexion
Pronation and supination

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14
Q

What special tests are there in a wrist exam?

A

Finklestein’s (hand in ulnar deviation, push thumb in ulnar direction - positive result = pain = De Quervain’s tenosynovitis)
Eichoff’s (thumb across palm of hand, make fist and bend in ulnar deviation - positive result = pain = De Quervain’s tenosynovitis)
Scaphoid compression (positive test = pain in anatomical snuff box = scaphoid fracture)
Tinnel’s (tap volar aspect of carpal tunnel - positive test = pain or neuro symptoms over median nerve distribution = carpal tunnel syndrome)
Phalen’s (maximally flex wrist positive result same as Tinnel’s)

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15
Q

What are you LOOKING for in an elbow exam?

A

Deformity
Carrying angle
Swelling over lateral aspect (effusion)
Swelling over olecranon process (bursitis)
Gouty tophi
Psoriatic plaques
Rheumatoid nodules on proximal extensor surfaces of forearm

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16
Q

What are you FEELING for in an elbow exam?

A

Olecranon
Lateral and medial epicondyles
Radial head
Bony contours
Valgus and varus stress (MCL and LCL)

17
Q

Which movements do you test in an elbow exam?

A

Flexion and extension (and hyperextension with shoulder at 90 degrees)
Pronation and supination

18
Q

What are the special tests in an elbow exam?

A

Tinel’s (tap cubital tunnel posterior to medial epicondyle - positive test = symptoms exacerbated = cubital tunnel syndrome)
Froment’s test (hold piece of paper between thumb and index finger and resist examiner’s attempt to pull away - positive test = ulnar nerve palsy)
Tennis elbow (flex elbow to 90 degrees in pronation, ask patient to extend wrist or index finger against resistance - positive test = pain at lateral epicondyle and may be referred down extensor aspect of arm)
Golfer’s elbow (flex elbow to 90 degrees in supination, ask patient to flex wrist against resistance - positive test = pain at medial epicondyle and may be referred down te flexor aspect of arm)

19
Q

What are you LOOKING for in a hip exam?

A

Muscle mass with patient standing
Gait
Patient lying down -
- Erythema or skin changes
- Swelling
- Bruising
- Scars
- Attitude of limb

20
Q

What are you FEELING for in a hip exam?

A

Greater trochanter
Groin (mid-point and medially)

21
Q

Which movements do you test in a hip exam?

A

Flexion (passive and active)
Internal rotation (passive)
External rotation (passive)
Adduction (passive)
Abduction (passive)

22
Q

What are the special tests in a hip exam?

A

Trendelenurg test
Limb lengths (true and apparent)

23
Q

What are you LOOKING for in a shoulder exam?

A

Contour of shoulder
Deltoid and trapezius muscle bulk
Deformities of bones
Scars
Scapular asymmetry
Swellings and scars in the axillas

24
Q

What are you FEELING for in a shoulder exam?

A

Sternoclavicular joint, along clavicle, acromioclavicular joint, acromion process
Long head of biceps
Scapula spine and body

25
Q

What are the movements tested for in a spinal exam?

A

Forward flexion
Abduction (ask about painful arc)
External rotation (elbows by sides)
Internal rotation (hand on back)

26
Q

What are the special tests in a shoulder exam?

A

Hawkins-Kennedy (shoulder flexed, elbow at 90 degrees, internally rotate arm - positive result = pain = impingement)
Jobe’s test (shoulder flexed, arm straight, thumb pointing down, get patient to resist downward force - positive result = pain exacerbated = rotator cuff tear)
Sulcus sign
Anterior and posterior drawer (patient supine on bed, stabilise shoulder girdle with one hand, draw humeral head anteriorly and posteriorly)
Anterior apprehension (patient lying supine, elbow flexed, externally rotate shoulder)
Posterior apprehension (patient lying supine, shoulder and elbow both flexed at 90 degrees, exert pressure through the elbow)
Scarf test
Infraspinatous and teres minor weakness (elbows by sides and flexed at 90 degrees, get patient to resist your medial force)
Subscapularis (patient put hand just above buttocks and try to resist you pushing their hand towards them)

27
Q

What are you LOOKING for in a foot and ankle exam?

A

Examine footwear
Swelling
Nail changes
Bruising
Deformity
Get patient to stand on tip toes
Look for ulcers and callosities on sole of foot
Gait

28
Q

What are you FEELING for in a foot and ankle exam?

A

Lateral malleolus and lateral ligament complex
Anterior joint line
Medial malleolus and deltoid ligament
Achilles tendon
Bade of 5th metatarsal (pinkie toe)
Metatarsal heads on plantar surface
Pulses
Sensation

29
Q

Which movements do you test for in a foot and ankle exam?

A

Dorsiflexion and plantarflexion
Inversion and eversion
Metatarsal phalangeal movement

30
Q

What are the special tests in a foot and ankle exam?

A

Grind test
Anterior drawer test
Mulder’s click test (interdigital space on plantar aspect of foot)
Simmond’s test (patient’s feet hanging off edge of chair, squeeze calves - positive test = foot does not move = Achilles tendon rupture)

31
Q

What are you LOOKING for in a knee exam?

A

Limb alignment
Valgus/varus deformity
Muscle mass
Baker’s cysts
Gait
Erythema or skin changes
Bruising
Scars
Swelling

32
Q

What are you FEELING for in a knee exam?

A

Temperature
Tibial tuberosity
Patella tendon
Medial and lateral joint line
Medial and lateral collateral ligaments
Popliteal fossa
Bursa

33
Q

Which movements do you test for in a knee exam?

A

Flexion and extension (active and passive - feel for crepitus in passive)

34
Q

What are the special tests in a knee exam?

A

Straight leg raise

MSK (10 decks)

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