OSCE 2- tests (2)

Question 1

Valsalva’s maneuver procedure

Answer 1

doctor stands in front of seated patient

patient is asked to take a breath and bear down as if they were laboring during a strenuous defecation

Question 2

why would a patient become dizzy during valsalva’s maneuver?

Answer 2

decreased cerebral blood supply

Question 3

what are the findings with valsalva?

Answer 3

a sharp accentuation of pain at the level of the lesion usually indicates a space occupying lesion
note the location of the pain; it will help to identify the etiology of the pain

Question 4

what is the procedure of the swallowing test? What does this indicate?

Answer 4

while seated, the patient is instructed to swallow
presence of pain or difficulty swallowing indicates a…
space occupying lesion
ligamentous sprain
muscular strain
fracture
disc protrusion
tumor
osteophyte at the anterior protion of the cervical spine

Question 5

what is the procedure of Naffziger’s test?

Answer 5

doctor stands behind a seated patient and occludes the external jugular veins at the level of the clavicles for 10-15 seconds. the doctor then asks the patient to cough

Question 6

what are the findings of naffziger’s?

Answer 6

sharp accentuation of pain at the level of the lesion

note the location of the pain

Question 7

procedure for barr’e-Lie’ou test?

Answer 7

while patient is in a seated position, the doctor instructs the patietn to rotate the head back and forth as fast as they can. if at any time the patient experiences symptoms, the test is positive

Question 8

what is the purpose of the barr’e-Lie’ou test?

Answer 8

to rule out vascular insufficiency, cervicogenic vertigo, possible vestibular apparatus abnormality

Question 9

what is the proceudre of the vertebrobasilar arteyr functional maneuver?

Answer 9

while patient is in seated position, the doctor auscultates the carotid and subclavian arteries bilaterally
the doctor then palpates the carotid and subclavian arteries bilaterally. if no assymetrical or diminished pulsations are felt or no bruits exist, the doctor instructs the patient to rotate and hyper-extend the head to one side.
during full rotation and extension patient should coudn backward from 20 by 1’s. patient should then repeat the rotation and hyperestension on the other side and repeat
any symptoms indicates positive test

Question 10

what is the reporting statement for vertebrobasilar artery functional maneuver?

Answer 10

considered positive if either maneuver reveals bruits.
a positive finding indicates a buckling of the ipsilateral vertebral artery
vertigo, dizziness, visual disturbances, nausea, syncope and nystagmus are all positives
if it is positive on the right, the finding is on the right

Question 11

what symptoms suggests possible subclavian artery stenosis or occlusion?

Answer 11

a difference in how many mmHg between two systolic BPs and a feeble or absent radial pulse on the side of the feeble pulse

Question 12

procedure for deklyn’s test?

Answer 12

while patient is lying supine, doctor instructs the patient to rotate and hyper-extend the head to one side. during full rotation and extension the patient should cound back wards from 20 by 1’s
repeat on the opposite side
rotating head causes compression of vertebral arteries
test is positive if patient has symptoms

Question 13

what are the clinical indications for deklyn’s test?

Answer 13

rotation and hyper-extension protion of this rests places motion-induced compression on the vertebral arteries.
symptoms=positive= vertebral, basilar, carotid artery stenosis or compression

Question 14

what is the procedure for the distraction test?

Answer 14

with the patient seated, the doctor exerts upward pressure on the patient’s head. this removes the weight of the patient’s head from teh neck
hold for 30-60 seconds

Question 15

what does generalized, increased pain for the distraction test?

Answer 15

muscle spasm

Question 16

what does relief of pain indicate with the distraction test?

Answer 16

intervertebral foraminal encroachment

facet capsulitis

Question 17

what is the purpose of the distraction test?

Answer 17

confirm IVF encroachment

Question 18

what is the procedure for the foraminal compression test?

Answer 18

with the patient in the seated position the patient actively rotates the head from side to side. note pain and the location of the pain is present. the doctor then exerts strong downward pressure with the head in the neutral position, noting any radicular pain. doctor then rotates neck while exerting strong downward pressure on the head

Question 19

what is the purpose of the foraminal compression test?

Answer 19

to confirm IVF encroachment and nerve root involvement

Question 20

what is the procedure of the jackson compression test?

Answer 20

patient in seated position, the patient actively rotates the head from side to side. note pain. patient laterally flexes head, note pain. doctor exerts downward pressure on the head in a neutral position, note pain. doctor laterally flexes the patient’s neck wil exerting strong downward pressure on head. note pain. pressure maintained for 30-60 sec

Question 21

what is the purpose on the jackson compression test?

Answer 21

confirm IVF encroachment and nerve root involvement

Question 22

what is the reporting statement for jackson compression test?

Answer 22

positive on the right elicits pain in the cervical dermatome

Question 23

what is the maximum cervical compression test procedure?

Answer 23

while in the seated position, the patient is instructed to approximate the chin to the shoulder while fully rotating th ehead, laterally flex and then extend the neck
the test is performed bilaterally
pain on teh concave side indicates nerve root or facet involvement.
pain on convex side indicates muscular strain. note location of pain

Question 24

what is the purpose of the maximum cervical compression test

Answer 24

to confirm IVF encroachment and nerve root involvement

Question 25

procedure for spurling’s test

Answer 25

with the patient seated, patient actively rotates the head from side to side. note pain. if no pain continue
patient actively laterally flexes the head from side to side. note pain, if no pain continue
doctor exerts strong downward pressure with head in neutral position, note pain, if none, continue
doctor laterally flexes and extends the patient’s neck as far as tolerated, while exerting strong downward pressure on the head. note pain, if no pain continue
pressure maintained for 30-60 seconds
then doctor delivers a vertical blow to the uppermost portion of the crainum

Question 26

what is the purpose of spurling’s test?

Answer 26

confirm IVF encroacment and nerve root involvement

Question 27

procedure for lhermitte’s test

Answer 27

with patient seated the doctor instructs them to drop their chin to their chest. doctor then passively flexes the patient’s head

Question 28

purpose of lhermitte’s test

Answer 28

traction the posterior column of the spinal cord

Question 29

findings of lhermitte’s test

Answer 29

electroc shock like sensation radiating down the neck and spine is a sign of posterior column disease of the spinal ord and also a classic sign of MS
note location of pain

Question 30

procedure of the O’Donoghue maneuver

Answer 30

seated patient, cervical spinal is actively moved through range of motion, then through passive range of motion, then through resisted range of motion
test can be done on any joint of the body

Question 31

reporting statement for O’Donoghue

Answer 31

positive for strain of cervical spine

positive for muscular strain of cervical spine

Question 32

procedure of Kernig sign

Answer 32

patient is supine. doctor flexes the hip and knee of either leg to 90 degrees, respectively. doctor attempts to compretely extend the leg. if pain prevents this, headache will increase, sign is present
sign is often accompainied by involuntary fleion of the opposite knee and hip and is present in menintitis

Question 33

what is teh reporting statement of kernig sign

Answer 33

indicates meningeal irritation or inflammation

Question 34

procedure of brudzinski sign

Answer 34

patient is supine, doctor passively flexes the patient’s head. sign is present if flexion of both knees occurs. headache will increase
frequently accompainied by flexion of both hips and is present with menintitis

Question 35

reporting statement and clinical indication of brudskinski sign

Answer 35

meningeal irritation of rinflammation

Question 36

soulder depression test procedure

Answer 36

patient is seated and doctor stands behind and lateral to the mid line of he side being tested. doctor laterally flexes head away form side being tested. while stabilizing head, an inferior force is placed on the ipsilateral shoulder

Question 37

findings for shoulder depression test

Answer 37

fibrosis of IVF
adhesions to dural sleeve
tractioning nerve root across osteophytes
eema or compression of the nerve root at the IVF
radiating symptoms may also be caused by:
tractioning the nerves across a cerviclal rib
soft tissue involvement

Question 38

soto-hall procedure

Answer 38

patient is supine
doctor places one hand on sternum of patient and exerts slight pressure so that no flexion can take place at either hte lumbar or thoracic regions of the spine. doctor places other hand under patient’s occiput and passively flexes the head toward the chest

Question 39

findings of soto-hall

Answer 39

localized dull or sharp pain in the cervical spine that may radiate to the thoracic spine may be caused by:
sprain/strain
avulsion fracture
facet involvement
sharp accentuation of pain with radiculopathy suggests a possible space occupying lesion