OSCE Examinations Flashcards
Swelling (lump)
Ulcer
Respiratory
INSPECT
- hands, clubbing, temp, CRT
- tremor flapping/fine
- HR, RR, check the blood pressure
- JVP
- Eyes, face, mouth
- Chest
PALPATE
- trachea
- cricosternal distance
- apex beat
- chest expansion
- tactile vocal fremitus
PERCUSS
- all lobes
AUSC
- deep breaths
- vocal resonance
Repeat on back
END
- cervical lymph nodes
- sacral oedema
- ankle oedema
- sputum pot
- peak flow
- BP (could be stated earlier)
- O2 sats
To complete my examination, I’d like to check the sputum pot, assess peak flow, blood pressure and oxygen saturations
Cardiovascular
INSPECT
- Hands, clubbing, temp, CRT
- Both radials, one radial, brachial, collapsing pulse
- JVP + hepatojugular reflux, carotid pulse
- Eyes, face, tongue
- Chest
PALPATE
- Apex beat
- Heaves
- Thrills
AUSC
- 4 areas w diaphragm, palpate carotid pulse if sounds heard
- axilla w diaphragm
- roll left, bell at apex, expiration
- sit forward, diaphragm at 4/5 ICS, expiration
- lung bases, sacral oedema
- sit back, auscultate carotids
END
- lie down, hepatosplenomegaly
- pedal oedema
- lying/standing BP, BP in both arms
- femoral pulses, radio-femoral delay
- ophthalmoscopy for hypertensive retinopathy
- 12-lead ECG
To complete my examination, I’d like to check the femoral pulses and assess for radiofemoral delay, check blood pressure in both arms and perform a lying/standing blood pressure in one arm, perform ophthalmoscopy and obtain a 12-lead ECG.
Gastrointestinal
INSPECT
- hands, clubbing, temp, CRT
- liver flap
- HR
- Eyes (inc jaundice)
- Face, mouth
- Palpate lymph nodes in neck and Virchow’s
- Chest
- Abdo
- Back- then get patient to lie back before palpation
PALPATE
- 9 areas superficial
- 9 areas deep
- liver
- spleen
- kidneys
- bladder
- aortic pulses
- Murphy’s
PERCUSS
- liver
- spleen
- bladder
AUSC
- Bowel sounds
- Aortic (femoral) bruits
END
- Inguinal lymph nodes
- Stools
- Hernial orifices (femoral and inguinal)
- Rectal examination
- Urinalysis
- Genitalia
To complete my examination, I’d like to check axilla and inguinal lymph nodes, a stool sample, examine the femoral and inguinal hernial orifices, perform a rectal examination, urinalysis and examine the external genitalia.
Neuro: Upper Limb
- L/R handed
- Pronator drift (eyes closed?)
- Inspect generally
TONE
- move each joint
POWER
- shoulders
- elbows
- wrists
- fingers
- thumb, inc opposition
REFLEXES
- biceps
- triceps
- supinator
COORDINATION
- finger to finger
- finger to own nose, eyes closed
- fine movts (piano-playing)
- dysdiadochokinesis
SENSATION
- soft touch
- proprioception
- vibration (128Hz)
- cortical localisation + stereogenesis
- pain / temp (describe)
To complete my examination, I’d like to do a lower limb neurological examination and a full cranial nerve examination
Neuro: Lower Limb
- Gait - normal / heel-toe
- Romberg’s (eyes open + closed)
- General inspection
TONE
- each joint
POWER
- hip
- knee
- ankle
- big toe
REFLEXES
- knee
- ankle
- plantar
- ankle clonus
COORDINATION
- heel-shin
SENSATION
- soft touch
- proprioception
- vibration (128Hz)
- pain / temp
To complete my examination, I’d like to do an upper limb neurological examination and a full cranial nerve examination
Cerebellar
- general, inc stance
- stand from sitting with arms folded
- gait, normal + heel-toe
- Romberg’s
FACE
- speech- “baby hippopotamus, British constitution”
- H test, pause at lateral, ask about double vision
- look from target to target (paused lateral to face)
UPPER LIMBS
- finger to nose test
- rebound test
- tone
- dysdiadochokinesia
LOWER LIMBS
- tone
- heel-shin
- knee reflex
To complete my examination, I’d like to do an upper + lower limb neurological examination and a full cranial nerve examination.
Mental state examination
Appearance/behaviour
- build, dress, hygiene, self-neglect
- engagement, eye contact, anxious, disinhibited, gait/posture
Speech
- rate (eg pressured), rhythm, tone (eg monotonous), volume
Emotion (Mood/Affect)
- subjective - pt’s view of own mood
- objective - your assessment of their mood
- affect - their outward expression of their emotions
Perceptions
- illusions
- hallucinations - auditory, visual, tactile, gustatory, olfactory
- derealisation/depersonalisation
Thoughts
- stream - pressure, poverty, blocking
- form - flight of ideas, loosening of associations, perseveration
- content - delusions, obsessions, over-valued ideas
- self-harm / suicide
Insight
- aware of own mental illness?
- willing to comply with treatment?
Cognition
- MMSE / AMT
Groin examination for hernias
Scrotal swellings
GALS
QUESTIONS
- pain / stiffness in muscles, joints, back
- dress/undress
- climb up/down stairs
INSPECT
- standing, front, side, back
GAIT
- walk, ?pain
SPINE
- lumbar flexion
- lateral neck flexion, ROM, ?pain
ARMS
- hands behind head, push shoulders back
- hands - palms up/down with straight elbow (inspect)
- MCP squeeze
- make fist
- squeeze fingers
- finger to thumb
LEGS
- active knee flexion/extension
- internal/external rotation of hip (90 degrees at hip/knee)
- patellar tap / bulge test
- inspect feet
- MTP squeeze
To complete my examination, if any abnormalities were detected, I would perform a regional examination of the musculoskeletal system
Hip
LOOK
- standing - front, back, side
- gait
- Trendelenburg test
- lying
- true / apparent leg length - from tibia/femur
FEEL
- bony tenderness
- swelling
- temp
MOVE
- Active - flexion, abduction, adduction
- Passive, inc internal/external rotation (extended and flexed)
END
- Thomas test
- lumbar spine, ipsilateral knee
- lower limb neurovascular exam
To complete my examination, I’d like to examine the patients lumbar spine and ipsilateral knee joint and perform a full neurological and vascular examination of the patient’s lower limb
Knee
LOOK
- standing - front, back, side
- gait
- lying
FEEL
- temp
- bony tenderness
- popliteal cyst/swelling
- bulge test
- patellar tap
- flex to 90, joint line tenderness
MOVE
- Active flexion, extension
- Passive, crepitus
SPECIAL
- posterior sag
- anterior draw
- LCL
- MCL
- Lachman’s
- McMurray’s
END
- ipsilateral hip, ankle
- neurovascular status of limb
To complete my examination, I’d like to examine the patients ipsilateral hip and ankle and perform a full neurological and vascular examination of the patient’s lower limb
Ankle and foot
LOOK
- shoes
- standing - front, back, side
- stand on toes
- gait
FEEL
- Achilles thickening
- lie down, inspect- remember toes and heel
- temp
- tenderness- ankle area and foot
- MTPJ squeeze
MOVE
- Active - dorsi, plantar, invert, evert, toe dorsi/plantar
- Passive, inc at subtalar joint, toe
END
- ipsilateral knee
- limb neurovascular status
Spine
Any pain in neck or back?
LOOK
- front, side, back
- gait
FEEL
- palpate spine, inc SI joints
- paraspinal muscles
MOVE
- c-spine - flexion, extension, lateral flexion, rotation
- touch ground
- modified Schober’s
- arch back
- bend side to side
- sit down, arms crossed, twist side to side (thoracic)
SPECIAL
- straight leg raise
- bowstring test
- femoral stretch test
END
- neuro upper + lower limbs
- if lower back pain - abdo, rectal, perineal
- peripheral pulses (claudication)
- neck pain - shoulder
- back pain - hips
To complete my examination, I’d like to perform a full neurological and vascular examination of the patients upper and lower limbs, examine the hip and shoulder joints, examine the peripheral pulses and in a patient with lower back pain perform an abdominal examination and consider a rectal examination
Shoulder
- ?dress w/o difficulty
- wash own hair
LOOK
- front, back, side
FEEL
- temp
- palpate bones
- palpate muscle
MOVE
- hands behind head, elbows back
- hands behind back, up back
- active - external / internal rotation, flexion, extension, abduction
- passive
SPECIAL
- resisted active abduction
- resisted active internal / external rotation
- scarf test
- Jobe’s empty can
END
- c-spine
- elbow
- neurovascular status of limb
To complete my examination, I’d like to examine the patients cervical spine and elbow joints and perform a full neurological and vascular examination of the patient’s upper limbs
Elbow
LOOK
- front, side, back
FEEL
- temp
- elbow at 90, palpate bones
MOVE
- active flexion, extension, pronation, supination
- passive, crepitus
- pt move hand to nose
SPECIAL
- Golfer’s elbow
- Tennis elbow
END
- limb neurovascular status
- ipsilateral shoulder, wrist/hand
Hand
LOOK
- nails
- dorsum
- palmar
- elbow
FEEL
- temp
- palpate bones (snuffbox)
- MCPJ squeeze
- sensation in dermatomes / nerve distributions
- ulnar / radial pulses
- Allen’s test
MOVE
- fingers - flexion, extension, abduction, adduction
- thumb - flexion, extension, abduction, adduction, opposition
- wrist dorsi/palmar flexion, radial/ulnar deviation
GRIP
- hold pen, stop me pulling it out (grip fingers)
- key grip
- do up button
- paper between fingers- stop pulling out
SPECIAL
- CTS (median)
- Ulnar
- Radial
END
- elbow
To complete my examination, I’d like to examine the patients elbow joint if the patient has pain/restricted movement at the wrist joint and perform a full neurological and vascular examination of the patient’s upper limbs
Peripheral vascular
INSPECT
- general
- hands, CRT, temp
- radial pulses
- ulnar, brachial pulses
- Allen’s test
- BP both arms
- carotid pulses
- eyes, lips, tongue
- abdo
- legs, feet, toes
PALPATE
- aorta
- femoral pulses
- popliteal pulses
- dorsalis pedis, posterior tibial
- light touch + CRT in toes
- power in foot/leg
AUSC
- carotids
- subclavian arteries
- aorta
- femoral arteries
END
- Buerger’s
- ABPI (leg/arm, <0.8 is significant)
Lower: To complete my examination, I’d like to perform an upper limb peripheral arterial examination, measure the ABPI, perform a foot examination and measure the blood glucose
Upper: To complete my examination, I’d like to perform a lower limb peripheral arterial examination, measure the ABPI and measure the blood glucose
Lower limb venous
- inspect legs
- inspect SFJ
- SFJ cough test + palpate thrills
- tap test
- tourniquet test
- Perthe’s test
- auscultate SFJ with doppler
- doppler auscultation at saphenopopliteal junction
- examine abdo
To complete my examination, I’d like to perform an abdominal + peripheral arterial examination and obtain a doppler ultrasound of any varicosities
Thyroid
INSPECT
- hands, nails, temp, clubbing
- fine tremor with paper
- pulse
- forearms
- eyes, inc from back
- eye movts (H), lid lag
- visual acuity, fundoscopy
- neck, swallow, stick tongue out
- back of tongue
PALPATE
- trachea central
- neck (from behind), bones then laterally
- swallow / stick tongue out whilst palpating
- cervical lymph nodes
PERCUSS
- down to sternum
AUSC
- w bell, over thyroid, hold breath
END
- stand from chair w arms crossed
- ankle reflexes
- inspect shins
To complete my examination, I’d like to take an ECG if there was an irregular pulse, conduct thyroid function tests and obtain further imaging such as an ultrasound
Breast
(Chaperone)
INSPECT
- symmetry (contours, tethering, dimples in skin)
- visible masses
- erythema of skin/ abnormal scaling
- inspect nipple retraction
- ask patient to put hands behind head with shoulders back
- hands on hip and push inwards
PALPATE
- all four areas, axillary tail and nipple
- elevate breast to look for hidden pathology
- palpate the axilla
- supraclavicular fossa + cervical lymph nodes
FINISH
- if supected cancer or hx, palpate and purcuss abdomen for hepatomegaly (state this in exam)
Diabetic foot
INSPECT
- general
- gait, shoes
- feet - skin, pressure points, ulcers, webspaces, deformities
PALPATE
- bones + joints for swelling/tenderness
VASCULAR
- temp
- pulses - DP, PT, pop, femoral (omit)
- CRT
NEURO
- ankle jerk
- light touch
- pressure (10g monofilament)
- proprioception
- vibration (128Hz)
- pin prick, temp
To complete my examination, I’d like to examine the patients cervical spine and elbow joints and perform a full neurological and vascular examination of the patient’s upper limbs
