OSCE

Question 1

Upper limb

What is pronator drift? What does it indicate?

Answer 1

Pronator drift involves both pronation (rotation of the forearm/wrist from palm up towards a palm down position) and downward movement of an upper limb (i.e. drift). The presence of pronator drift indicates a contralateral corticospinal tract lesion.

Pronation occurs because, in the context of an UMN lesion, the supinator muscles of the forearm are typically weaker than the pronator muscles.

Question 2

Upper / Lower limb

MRC Muscle Power Scale

Answer 2

Question 3

Upper limb

Shoulder ABduction
Myotome assessed:____

Muscles assessed: ____

name the nerve too

Answer 3

Myotome assessed: C5 (axillary nerve)

Muscles assessed: deltoid (primary) and other shoulder abductors

Question 4

Upper limb

Shoulder ADduction
Myotomes assessed: ____

Muscles assessed: (3)

name the nerve too

Answer 4

Myotomes assessed: C6/7 (thoracodorsal nerve)

Muscles assessed: teres major, latissimus dorsi and pectoralis major

Question 5

Upper limb

Elbow flexion
Myotomes assessed: ____

Muscles assessed: (3)

name the nerve too

Answer 5

Myotomes assessed: C5/6 (musculocutaneous and radial nerve)

Muscles assessed: biceps brachii, coracobrachialis and brachialis

Question 6

Upper limb

Elbow extension

Myotome assessed: ____

Muscles assessed: ____

name the nerve too

Answer 6

Myotome assessed: C7 (radial nerve)

Muscles assessed: triceps brachii

Question 7

Upper limb

Wrist extension
Myotome assessed: ____

Muscles assessed: ____

name the nerve too

Answer 7

Wrist extension
Myotome assessed: C6 (radial nerve)

Muscles assessed: extensors of the wrist

Question 8

Upper limb

Wrist flexion
Myotomes assessed: ____

Muscles assessed: ____

name the nerve too

Answer 8

Myotomes assessed: C6/7 (median and ulnar nerve)

Muscles assessed: flexors of the wrist

Question 9

Upper limb

Finger extension
Myotome assessed: ____

Muscles assessed: ____

name the nerve too

Answer 9

Myotome assessed: C7 (radial nerve)

Muscles assessed: extensor digitorum

Question 10

Upper limb

Finger ABduction
Myotome assessed: ____

Muscles assessed: (2)

name the nerve too

Answer 10

Myotome assessed: T1 (ulnar nerve)

Muscles assessed:

First dorsal interosseous (FDI)
Abductor digiti minimi (ADM)

Question 11

Upper limb

Thumb ABduction
Myotomes assessed: ____

Muscle assessed: ____

name the nerve too

Answer 11

Myotomes assessed: T1 (median nerve)

Muscle assessed: abductor pollicis brevis

Question 12

Upper limb

What spinal roots does the biceps reflex originate from?

Answer 12

(C5/6)

Question 13

Upper limb

What spinal roots does the triceps reflex originate from?

Answer 13

(C7)

Question 14

Upper limb

What spinal roots does the supinator reflex originate from?

Answer 14

(C5/6)

Question 15

Upper limb

Pin-prick (pain) sensation involves the ____ tracts.

Answer 15

spinothalamic

Question 16

Upper limb

Point to C5-T1 on yourself.

Answer 16

Question 17

Upper limb

Joint proprioception, also known as joint position sense, involves the ____.

Answer 17

dorsal columns

Question 18

Upper limb

Vibration sensation involves the ____.

Answer 18

dorsal columns

Question 19

Upper limb

What kind of sensory loss from “glove and stocking” distribution describe?

Answer 19

peripheral neuropathy

Question 20

Upper limb

What kind of sensory loss describes a localised sensory disturbance in the area supplied by the damaged nerve?

Answer 20

Mononeuropathies

Question 21

Upper limb

What kind of sensory loss occurs due to nerve root damage (e.g. compression by a herniated intervertebral disc), resulting in sensory disturbances in the associated dermatomes?

Answer 21

radiculopathy

Question 22

Upper limb

What results in sensory loss both at and below the level of involvement in a dermatomal pattern due to its impact on the sensory tracts running through the cord?

Answer 22

Spinal cord damage

Question 23

Upper limb

What kind of pathology result in contralateral sensory loss?

Answer 23

Thalamic lesions (eg stroke)

Question 24

Upper limb

What kind of pattern of sensory loss often involves symmetrical proximal muscle weakness.

Answer 24

Myopathies

Question 25

Upper limb

____: refers to a lack of coordination of movement. Clinically this results in the patient missing the target by over/undershooting.

Answer 25

Dysmetria

Question 26

Upper limb

____: a broad, coarse, low-frequency tremor that develops as a limb reaches the endpoint of a deliberate movement. Clinically this results in a tremor that becomes apparent as the patient’s finger approaches yours.

Answer 26

Intention tremor

Question 27

Upper limb

What test can we use to assess coordination?

Answer 27

Finger-to-nose test

Question 28

Upper limb

What is a term that describes the inability to perform rapid, alternating movements, which is a feature of ipsilateral cerebellar pathology?

Answer 28

Dysdiadochokinesia

Question 29

Upper limb

The presence of dysdiadochokinesia suggests ____lateral ____ pathology.

Answer 29

ipsilateral cerebellar

Question 30

Upper limb

Light touch sensation involves both the ____ and ____

Answer 30

dorsal columns
spinothalamic tracts