Osce Exams

Question 1

What do you comment on in antenatal exam?

Answer 1

Single baby
Comment on linea negra and striations (not stretch marks!)
Longitudinal / transverse / oblique line with
the back in mams left/right?
Cephalic or breach
Baby head fixed 5/5 not fixed 0/5 fully fixed
Symphasis fundal height
Fetal heart 130 to 250

Question 2

In CVD exam what is possible stigmata of disease around bedside?

Answer 2

IV FLUIDS, medications, monitors oxygen

Question 3

In RESP exam what is possible stigmata of disease around bedside?

Answer 3

Oxygen, sputum pots, peak flow meters

Question 4

In Abdo exam what is possible stigmata of disease around bedside?

Answer 4

Feeds- NG, TPN

Vomit bowls

Question 5

In Neuro exam of the lower limb what is possible stigmata of disease around bedside?

Answer 5

Motility aids, orthotics, medications

Question 6

In CVD exam what do you examine hands for?

Answer 6

Cap refill, Peripheral cyanosis (poor perfusion)
Splinter hemorrhages (infective endocarditis)
Clubbing (cynaotic congenital heart disease, chronic lung disease, inflammatory bowel disease)
Koilonychia (iron deficiency anaemia)
Cap refill time

Question 7

In Resp exam what do you examine hands for?

Answer 7

Temperature,
Peripheral cyanosis (potential hypoxia)
Clubbing ( congenital heart disease, chronic lung disease, IBD)
cap refill

Question 8

In Abdo exam what do you examine hands for?

Answer 8

Cap refill time ( good marker of hydration status)
Asses skin turgor (another useful marker of hydration status)
Clubbing, koilonychia, leukonychia, palmar erythema (raised oestrogen secondary to hepatic failure)

Question 9

Paeds CVE what to look for during general inspection

Answer 9

Nutritional status 
Scars or deformities 
Level of respiratory effort 
Cyanosis 
Obvious dysmorphic syndromes such as Down’s or ​
Marfan’s syndrome

Question 10

Paeds RESP exam what to look for in general inspection?

Answer 10

Nutritional status
Scars or deformities
Level of respiratory effort
Cyanosis

Question 11

Paeds abdo exam what to look for in general inspection?

Answer 11

Alertness 
Interest in surroundings 
Jaundice 
Posture (if experiencing abdominal pain their knees may be drawn up to chest or lying very still) 
Rash (dermatitis herpetiformis)
Bruising
Nutritional status

Question 12

In Abdo exam what do you check hands for?

Answer 12

Cap refill, skin turgor, clubbing, koilonychia, leukonychia, palmar erythema

Question 13

What is leukonychia?

Answer 13

White spots on nails, Caused by hypoalbuminaemia.

Question 14

What is clubbing?

Answer 14

Deformity of the finger nail, Can be caused by cyanotic congenital heart disease, chronic suppurative lung disease, inflammatory bowel disease.

Question 15

What is koilonychia?

Answer 15

Spooning of the finger nails caused by iron deficiency anaemia

Question 16

What is palmar erythema?

Answer 16

Redness of the palms caused by raised oestrogen secondary to hepatic failure

Question 17

In paediatric cve what do you check in pulses for?

Answer 17

Radial pulse rate and rhythm (do breathing rate same time)
Radio-radial delay 
Offer radio-femoral delay
Collapsing pulse
Offer Blood pressure
Carotid pulse

Question 18

What is radio-radial delay?

Answer 18

Delay or absence of the radial pulse can be seen in coarctation of the aorta or aortic dissection. Absence of femoral also seen in coarctation

Question 19

How to check collapsing pulse?

Answer 19

Raising the patient’s arm quickly to shoulder height (check for any pain first) while holding the lower arm
If present it will feel like a tapping impulse radiating through the forearm musculature

Question 20

What is present collapsing pulse an indication of?

Answer 20

aortic regurgitation or a patent ​
ductus arteriosus

Question 21

What to look for when palpating carotid pulses?

Answer 21

Low volume seen in aortic stenosis or circulatory ​insufficiency
High volume seen in anaemia or if the child is stressed
Pulsus parodoxus (pulse weakens on inspiration) can be seen in cardiac tamponade or constrictive ​
pericarditis
Exaggerated carotid pulsations can be seen in aortic ​
regurgitation (Corrigan’s Sign)

Question 22

Paeds CVE what do you check face for?

Answer 22

Eyes: conjunctival pallor (anaemia), jaundiced sclera (CHF with hepatic congestion)
Cheeks: mitral flush (increased haematocrit in cyanotic heart disease)
Mouth: central cyanosis, dentition, high arched palate (Marfans)

Question 23

Paeds resp exam, what do you check face for?

Answer 23

Eyes: conjunctival pallor
Mouth: central cyanosis, hydration status

Question 24

Paeds Abdo exam, what do you check face for?

Answer 24

Eyes: jaundice, conjunctival pallor, Kayser-Fleischer rings (copper deposition secondary to hepatic disease)
Mouth: ulceration (crohn’s), central cyanosis, halitosis

Question 25

Paeds CVE, what to look for in chest inspection?

Answer 25

Ask patient to put hands on hips.
Operative scars 
Respiratory distress
Precordial bulge (cardiac enlargement)
Ventricular impulse (hyper-dynamic circulation or left ventricular hypertrophy but is normal in thin children

Question 26

In paeds resp exam what to look for in chest inspection?

Answer 26

Hands on hips!
Operative scars 
Respiratory hard work
Central lines or ports 
Changes in chest shape or chest wall deformities:
Hyper-expanded barrel shaped chest (poorly ​
controlled asthma), Pectus excavatum, Pectus carinatum, Harrison’s sulcus (poorly controlled asthma)
Spinal curvatures - scoliosis, kyphosis 
Asymmetry of movement

Question 27

Paeds Abdo exam what to look for on close inspection of abdomen?

Answer 27

Distention,
movement with respiration,
Operative scars

Question 28

Paeds CVE what do you palpate for?

Answer 28

Apex beat- count ribs (between 4th and 5th)
Thrills and heaves along sternal, border and suprasternal notch. Sign of ventricular hypertrophy.
Offer to palpate liver at the end

Question 29

How do you check for thrills and heaves?

Answer 29

Thrills: place hand over 4 valve areas of the heart- feels like cat purring (grade 4 murmurs)
Heaves: place heel of hand on left sternal edge- feels like hand being lifted off chest wall with each systole (ventricular hypertrophy)

Question 30

CVE what do you perform auscultation for?

Answer 30

SIMULTANEOUSLY PALPATE COROTID
Apex 
Lower left sternal edge
2nd inter coastal space left sternal edge
2nd intercostal space right sternal edge
Apex with bell roll on side hold breath.
Below left clavicle ( patent ductus arteriosus)
Left inter-scapular region (coarctation)
Lung bases

Question 31

In paeds resp exam, what do you palpate for?

Answer 31

Chest expansion, apex beat (count ribs) offer to check for tracheal deviation

Question 32

In paeds abdominal exam what do you palpate?

Answer 32

Light and deep palpation of all 9 quadrants, start at site furthest away from pain.
Palpate liver, spleen and kidneys

Question 33

In paeds Abdo exam what do you percuss?

Answer 33

Liver, spleen and shifting dullness ( if there’s distention)

Question 34

In paeds Abdo exam what do you auscultate?

Answer 34

Bowel sounds and renal artery bruits

Question 35

In paeds resp exam what do you percuss?

Answer 35

All lung zones, listen for:
Localised dullness (collapse, consolidation or fluid)
Hyper-resonance (bronchiolitis, severe asthma or ​
pneumothorax)

Question 36

In paeds resp exam what do you auscultate?

Answer 36

All lung zones including axillae.
Listen for the quality and symmetry of breath sounds, paying particular attention to added sounds such as:
Stridor - a low pitched inspiratory sound indicative of upper airway obstruction, such as in croup
Wheeze - a high pitched expiratory sound indicative of distal airway obstruction, such as in asthma
Crackles - moist sounds from the opening of ​
bronchioles, such as in pneumonia